Northlight Counseling Associates, Inc.
(602) 285-9696
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Patient Forms

Download Forms

Please download our forms below to fill out and bring into your next appointment. Any questions, please call us at 602-285-9696. 

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Registration Form

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Release/Authorization Form

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Child and Adolescent Intake

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GAD-7

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Refresh Good Faith Estimate

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PCP Notification Form

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Consent to Treatment

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Northlight Clients Responsibilities

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PHQ-9

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Privacy Practices

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Protecting Your Privacy

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Financial Agreement/CC Auth

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Post Visit Satisfaction Visit

Fill Out Forms Online

In lieu of printing, you may also fill out our forms online. Access each form using the buttons below. This will save time, and paper!


Adult Registration Packet


Consent to be Contacted for Post-Visit Satisfaction Survey Form


Refresh Good Faith Estimate


Release of Information Form


Tele Mental Health Informed Consent


GAD – 7


Child & Adolescent Packet


Client Consent to Allow PHI
by Email or Text


PHQ – 9

Northlight Counseling Associates, Inc.
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Copyright © 2023 Northlight Counseling Associates, Inc.
All rights reserved. Privacy Policy | Notice of Privacy Practices | Terms of Use | No Surprise Act

Phone: (602) 285-9696 | Fax: (602) 277-5930

Location Pin 2633 E. Indian School Road, #360, Phoenix, AZ 85016
Location Pin 4121 E. Valley Auto Drive, #122, Mesa, AZ 85206

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