Documents

Choose one method to complete the form:

- Adult Data Sheet - BY PEN - If you plan to print then complete by hand

- Adult Data Sheet - ON COMPUTER - If you plan to complete on computer then print

(your firewall may object - follow prompts to accept the download and enable editing)

Bring a completed printout with you to your initial session. Please do not email this document to me.

Choose one method to complete the form:

- Child Data Sheet - BY PEN - If you plan to print then complete by hand

- Child Data Sheet - ON COMPUTER - If you plan to complete on computer then print

(your firewall may object - follow prompts to accept the download and enable editing)

Bring a completed printout with you to your initial session. Please do not email this document to me.

P.O. Box 77819

Greensboro, NC, 27417

Phone: 844-622-3572 or 336-217-6007

Fax: 336-217-9450

M. Brett Debney, MS, EdS, LCMHC, CCMHC

Phone: 336-686-3555

Hours of Operation

Mon-Thur: 10a - 7pm

Fri: 10a - 4p

Sat & Sun: Closed

Address

3707 West Market Street, Suite D

Greensboro, NC 27403