Client Intake Form
After Your First Initial Call with Cornerstone of Hope and Before Your First Appointment
Thank you for contacting Cornerstone of Hope Lima! Prior to your first scheduled appointment you will need to fill out our intake form located below. For questions regarding the intake form, please contact our office at 419-581-9138.
Click Here For Child Intake Form Online
This form is to be filled out by parent/guardian of the child/teen if under the age of 18. The form is to be filled out using child/teen details.
Please fill this form out if you're over the age of 18. If coming for couples counseling, each individual will need to fill out a separate form.
Cornerstone of Hope Lima is offering Telehealth services (secure online counseling) or phone counseling during this COVID-19 situation. If you are a new clients, contact our main office to start this process at 419-581-9138. If you are a current client, please contact your counselor to begin these services. For any other questions, please contact our main office.
If you have not completed a Telehealth informed consent form, please click on the link above.
In addition, please review the "How to prepare for your first Telehealth session" guidelines.
Authorization & Consent For Release Of Information