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Forms

For Therapy Clients:

All of the forms below (excluding the Reiki Consent Form) are intended for use by those who are seeking Marriage and Family Therapy services. Please be advised that we will need for you to print these out, sign them, and bring them with you for your FIRST appointment or session. The form entitled “Client Rights and Limits to Confidentiality” is for YOU to keep for your own records. Please let us know if you have any questions regarding the content of these forms, and we will readily discuss any and all issues you might have.

For Reiki Clients:

Please print and sign the document entitled “Reiki Consent Form,” to bring to your first scheduled appointment.

Client Concerns

[gview file="/client-docs/Client_Concerns.doc"]

Client Intake Form

[gview file="/client-docs/Client_Intake_Form1.doc"]

Client Rights and Confidentiality

[gview file="/client-docs/Client_Rights_and_Limits_of_Confidentiality1.doc"]

Consent for Treatment

[gview file="/client-docs/Consent_for_Treatment_Form1.doc"]

Phone and and Email Discretion Form

[gview file="/client-docs/Phone-Email_Discretion_Form1.doc"]

Our Mission Statement

[gview file="/client-docs/Mission_Statement-Biz_Philosophy.doc"]

Reiki Consent Form

[gview file="/client-docs/Reiki_Consent_Form.doc"]

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Awards

Chi Sigma Iota

Chi Sigma Iota Foundation

Nora Ann Brucklacher is a member of the Chi Sigma Iota Foundation, which recognizes excellence in performance and honors in academic achievement amongst those who graduate in the counseling profession.


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American Psychological Association

Nora Ann Brucklacher is also accredited by the American Psychological Association, which affirms her professional integrity and intentions towards maintaining the highest standards of ethical mandates as set by the profession of Marriage and Family Therapists.

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American Association of Marriage and Family Therapists

Nora Ann Brucklacher is accredited and associated with AAMFT- The American Association of Marriage and Family Therapists, which is only possible through the continued registration and accreditation of her professional accrual of hours and ethical upstanding in the field of Marriage and Family Therapy.

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