The following items are needed for your intake appointment and may be downloaded by clicking on the item below. Documents can be uploaded to the client portal, emailed to contact@lillybrookcs.com, or brought with you to your appointment.  Call 248-250-6620 to confirm which documents you will need to complete.  ALL NECESSARY DOCUMENTS ARE NEEDED AT THE TIME OF INTAKE.

All Clients

      Credit Card Form 

      Informed Consent to Treat

      Notice of Privacy Practices

      Program rules

      Recipient Rights 

      

Individual Therapy

      Child & Adolescent Screening Form

      Adult Screening Form

      Readmission Intake Form - To be completed by all clients returning to therapy less than a year last seen. 

             For Readmission, please also complete an Informed Consent to Treat

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Family Therapy

All adult parties participating in therapy most also complete the documents listed under "All Clients." 

      Family Information Form  - To be completed by each head of household. 

      Personal Information Form - To be completed by every member of the family participating in therapy. 

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Marriage/Partner Relational

All parties must also complete the forms listed under "All Clients."

      Informed Consent to Treat - To be completed by both parties participating in therapy. 

      PR Personal History Information -  To be completed by both parties participating in therapy. 

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Professional Consultation

      Professional Consultation Consent 

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Telemedicine/Telehealth

Please also complete all  necessary paperwork pertaining to the service being rendered (i.e. Individual Therapy, Family Therapy, Marriage/Partner Relational, Professional Consultation. 

      Telehealth Client Instructions