Helpful Forms

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:


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For the office:

Demographics

Direct Referral Form

GAD

PHQ

Release of Information

Pre-Authorized Credit Card Use

LLPC Disclosure

Intern Disclosure

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Helpful Forms

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Shuntai Walker, MA, LPC, NCC
Counseling in Flint, Michigan
Central Office:
1121 Villa Linde Ct. Suite 39
Flint, MI 48532

counseling IN Flint, MI Call or Email For Appointment

 Office 810.515.1931   Fax: 800.276.5049 [email protected]