Avery Barber, MEd, LPC, NCC

Providing Confidential Assessment, Counseling and Referral
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If you have decided to set an appointment with me:
  • Call 704-633-4001 and make your appointment;
  • Print and complete the Registration form, the Health History form, the Substance Use History form, if applicable, and the Acknowledgement Receipt of Privacy Practices, and bring them to your first appointment;
  • Be sure to read the Notice of Privacy Practices before your first appointment and print a copy for your records.
  • Important Note: You will need Adobe Acrobat Reader to view the attached
    document(s). If you do not have Adobe Acrobat Reader, you can download it here.
    http://www.adobe.com/products/acrobat/readstep.html

     

If any of the following links do not work please report them by following this link.

Print ALL forms

 

Select individual forms for printing:

Registration

Health History