Forms
Unearth Healing & Wellness
Please fill out forms and consent forms and email them to Carolina.mirandalcsw@gmail.com before your scheduled session. These forms are providing consent for services, if they are not received before appointment, the session cannot take place.
Intake Questionnaire Adult- This questionnaire should be completed and signed for those seeking EMDR and/or Psychotherapy services. The initial session you have with provider is the initial assessment used to identify presenting symptoms and collaboratively develop tailored treatment plan. It is imperative you complete this before session as this vital information will help in the initial session.
Unearth Consent Form Packet 2021- This packet will need to be completed and signed for those seeking EMDR and/or Psychotherapy services. This packet needs to be completed and received by provider for intake to take place. Please note if you are paying cash or have purchased a package the hourly rate will be modified, and provider will email you a tailored packet reflecting your rate and payment options.
Sound-Energy Consent Form- This is a consent for sound/energy services. Please fill out and send to email before session.