Paperwork
Welcome to the Paperwork page of Hope Counseling Centers. Here you will find detailed information regarding paperwork that may be relevant to you. Review the information below to find out about our paperwork and the process for completion.
You may submit completed paperwork to us via:
- E-mail: contact@hopecounselingeap.com
- Fax: (863) 709-8118.
- Mail or Hand-delivery:
4404 S. Florida Avenue, Suite 3
Lakeland, FL 33813
Financial Aid Request Form:
Hope Counseling Centers offers a sliding scale program for clients that are in need of financial assistance. This program is available for those who do not have any other health insurance or benefits.
Following the submission of the Financial Aid Request form, your application will be reviewed and you will be contacted regarding your qualification for benefits.
Feel free to Contact Us to find out more about our financial assistance program.
Release of Information Form
For clients that wish to request a release of information to or from Hope Counseling Centers, please download and complete the following Release of Information Form. You can submit the form via mail, e-mail, fax, or in person.
New Client Paperwork
Paperwork for Cynthia Suich’s Clients:
Individual or Relationship Counseling:
*Please print and complete the paperwork prior to your first appointment (or submit completed paperwork via e-mail or fax), then bring it with you on the day of your appointment.*
Paperwork for Marie Satterwhites’s Clients:
Adult Individual Counseling:
Child Individual Counseling:
*Please print and complete the paperwork prior to your first appointment (or submit completed paperwork via e-mail or fax), then bring it with you on the day of your appointment.*
