Client Forms

Flower Gift In FoundationNow offering Telehealth Counseling for Intensive Outpatient and Group Therapy services.

Whether you are interested in individual, couples, family, group therapy, or our Intensive Outpatient Therapy program, we are happy to support you through the intake process. Our New Client Referral form allows us to gather basic information about your treatment needs to aid us in matching you with a therapist.

  • To get started, new clients should complete and submit our New Client Referral Form (link below). Please be sure to download and save the New Client Referral form to your device prior to filling it out, otherwise the PDF form will not save your information. In order to protect client’s privacy, the PDF form will not save your data unless it is saved to a private server prior to inputting any information.
  • Once completed, new client paperwork may be emailed, faxed, or mailed to our office at:
    Fax: (207) 799-1350
    Address: 100 Waterman Drive, Suite 201, South Portland, Maine 04016 (Attn: Intake Office)
  • If you do not receive a confirmation that we’ve received your new client paperwork within a week of sending it, please contact our intake office at or call 207-805-0181.
  • If you would prefer to complete the New Client Referral over the phone, please call the Intake Office at 207-805-0181 and leave your name, number, and the best day/time to contact you. The process of filling out the referral over the phone usually takes about 10-15 minutes to complete.

Release of Information Form

IMPORTANT: Instructions for completing/submitting the New Client Referral Form & Release of Information Form.

  1. First, download the form by clicking the link above and save it to your computer’s desktop. 
  2. Next, open the form on your computer and fill out all the fields.
  3. When you are finished, go to “SAVE AS” (under the File tab) and save your completed form on your computer’s desktop with a different name.
  4. To email your new client paperwork to us, please include which form(s) you would like to send as an attachment to
  5. To fax your new client paperwork to us, please fax to 207-799-1350 (Attn: Intake Office)
  6. To mail a hard copy of your new client paperwork to us, please send to 100 Waterman Drive, Suite 201, South Portland, Maine 04106 (Attn: Intake Office)