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    Maddy Day, LMFTA – Paperwork

    In order to save you time, I have uploaded my initial paperwork to this page.

    Please download and print off both files and bring them with you to the first session.

    The first three pages (Informed Consent) describe the therapy process and help describe what you should expect while working with me.

    The next two pages (Client Information Questionnaire) give you an opportunity to tell me about your expectations for therapy.

    The next two pages of the first packet are questionnaires that have been established to help people understand how satisfied they currently are with their relationship. Please fill out the Locke-Wallace MAT and the B.A.R.E.

    The final page is the Adverse Childhood Experiences Scale or ACES. It has been established to help people consider the experiences they had as a child and what, if any, impact it has on their level of functioning as an adult. For more information on the impact of adverse childhood experiences on the physical and emotional health of an individual go to:
    http://www.cdc.gov/violenceprevention/acestudy/about_ace.html

    The OQ-45 is a form that helps me determine your overall level of functioning. If you have any questions regarding these forms please do not hesitate to ask.

    Intake Paperwork for Maddy Day, LMFTA
    Download File

    OQ-45
    Download File