Associated Counseling Professionals
2255 S. 132 St. - Suite 200 - Omaha, NE
Mary Bozak, LIMHP
Habit control appointment? Skip the long forms! Special forms for
smoking cessation clients -- please download
form 1 and form 2.
Note:  you can skip the 6 page form above.
Need Adobe Reader?
Download it -- free -- by
clicking
here
When you open and print the forms file in
Adobe Acrobat Reader, make sure you
adjust your printer settings to
"auto-rotate", as seen in the illustration.
Phone: 402-334-1122
FAX: 402-334-8171
Choose the intake form based on the age
of the person receiving services.
Download - print - fill out these forms
before your first session.
Age 19 and above
Birth to 18
Adult forms
Child-Teen Forms
Mike Streeter, APRN - offers
assessments for medications used to help
with mood, anxiety, or depression

Mike's Intake Forms