Clear Life Counseling, LLC  

(860) 414-4245 Jackie@clearlifect.com

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We will connect within 48 business hours!

Clear Life Counseling, LLC​​

Please print and complete the following intake paperwork prior our first appointment.  You may also fax this paperwork in advance to (860) 973-0038 prior to our session.  If for some reason you forget to complete or bring this paperwork, it is important you arrive 15-20 minutes before our scheduled appointment time to complete the paperwork in my office.  Having this completed will allow us to start our session on-time and focus on the reasons that brought you to counseling. 

   Paperwork for Adolescent Clients to be completed by Guardian AND Client


   Paperwork for Adult Individual Clients


   Paperwork for Couples


Clear Life Counseling, LLC

UA-87730178-1