Thank you for choosing The Gentle Shepherd Counseling Center. To schedule your first appointment, please complete the appropriate new client forms, and our intake specialist will respond to you as soon as possible.
​

​Send completed forms to: info@gsccohio.com

Forms can also be dropped off or mailed to:
1469 South Main Street
North Canton, OH 44720

Adult Forms

Welcome Letter
File Size:	49 kb
File Type:	pdf

Download File

---

Policies and Procedures
File Size:	226 kb
File Type:	pdf

Download File

---

Adult Consent
File Size:	186 kb
File Type:	pdf

Download File

---

Adult History
File Size:	327 kb
File Type:	pdf

Download File

---

Late Cancel Payment Authorization
File Size:	136 kb
File Type:	pdf

Download File

---

Couples Therapy Consent
File Size:	123 kb
File Type:	pdf

Download File

---

Family Therapy Consent
File Size:	166 kb
File Type:	pdf

Download File

---

Marriage Therapy Consent
File Size:	71 kb
File Type:	pdf

Download File

---

Self-Pay Fee Application
File Size:	213 kb
File Type:	pdf

Download File

---

Release of Information
File Size:	239 kb
File Type:	pdf

Download File

---

Emergency Contact Release of Information
File Size:	51 kb
File Type:	pdf

Download File

---

HICF
File Size:	524 kb
File Type:	pdf

Download File

---

Child and Adolescent Forms

Welcome Letter
File Size:	49 kb
File Type:	pdf

Download File

---

Policies and Procedures
File Size:	226 kb
File Type:	pdf

Download File

---

Child and Adolescent Consent
File Size:	108 kb
File Type:	pdf

Download File

---

Child and Adolescent History
File Size:	342 kb
File Type:	pdf

Download File

---

Ages 12-17 Teen Checklist
File Size:	420 kb
File Type:	pdf

Download File

---

Late Cancel Payment Authorization
File Size:	136 kb
File Type:	pdf

Download File

---

HICF
File Size:	524 kb
File Type:	pdf

Download File

---

Release of Information
File Size:	239 kb
File Type:	pdf

Download File

---

Emergency Contact Release of Information
File Size:	51 kb
File Type:	pdf

Download File

---

Self-Pay Fee Application
File Size:	213 kb
File Type:	pdf

Download File

---

Notice: Weebly is a secure, encrypted website, but our email is not subject to the same level of security. However, any and all information provided through this intake is confidential and your responses will only be used by our office staff and counselors. We follow HIPPA regulations of client privacy and information security.

---