Clear Life Counseling, LLC

   Paperwork for Adult Individual Clients


   Paperwork for Couples


Contact Me

We will connect within 72 business hours!

Please print and complete the following intake paperwork and fax to (860) 973-0038 at least one day prior to our initial session. If you do not have access to a fax machine, see instructions below on how to Scan & Email documents from a phone.  If you need to complete the forms in office, please notify me at jackie@clearlifect.com and copies will be ready for you in the office waiting area however, you will need to arrive 20 minutes before our scheduled appointment time to complete the paperwork. Having this completed will allow us to start our session on-time and focus on the reasons that brought you to counseling. 

Clear Life Counseling, LLC  

(860) 414-4245 Jackie@clearlifect.com

Schedule and Appointment

Clear Life Counseling, LLC​​

How to Scan and Email documents on your iPhone if you do not have access to FAX

  1. Open Notes icon on your iphone and Create a new note.
  2. Tap the Camera button, then Tap Scan Documents.
  3. Center your document in view of the camera and take the photo.
  4. Tap Retake for a better picture or Tap Keep Scan if satisfied.
  5. Repeat steps 3 & 4 for each page. Tap Save then Tap Done.
  6. From the menu, select Send a copy then select Mail and address to jackie@clearlifect.comype your paragraph here.
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