Client Forms for Your First Appointment

Other Forms

Our Health Insurance Privacy and Portability Act (HIPPA) Policy

We require a completed release to exchange information

Adult Intake Packet
Child Intake Packet

If you are using insurance, please complete the highlighted sections on the HCFA form. 

If you are using insurance, please complete the highlighted sections on the HCFA form. 

All parties who have been court ordered to counseling must complete this packet and provide a copy of the court order

For couples, please list the name first for the person for whom you wish us to bill insurance under, and complete the HCFA with their name only.

We require consent from each person (parent or guardian) who has legal custody of the children. If there is joint legal custody, both parties must give consent prior to the first session.

Court Ordered Services Packet

If children are to be involved in services, we require consent from each person (parent or guardian) who has legal custody of the children. If there is joint legal custody, both parties must give consent prior to the first session, unless services are ordered by the court.

A New Dawn Psychotherapy Associates LLC

308 E Broad St

Bethlehem, PA 18018

p/ 610-861-8779

f/ 610-861-4677

e/ info@anewdawnpa.com

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A New Dawn Family Solutions

A New Dawn Family Solutions LLC

1180 Route 100

Bechtelsville, PA 19505

p/ 610-427-0619

f/ 610-861-4677

e/ info@andfs.com

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