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Christine Rummer Copeland, Ph.D.

Forms

Pier in Port Townsend

Intake Forms

Please read and fill out prior to your first session.

If you are meeting with me for psychotherapy, please bring the completed Intake forms with you or fill them out at my office 30 minutes ahead of your scheduled appointment. Alternative arrangements can be made for those who have accessibility issues. Please feel free to contact me at or call 360-774-0452 if you have any questions.

If you will be meeting with me for coaching, please read the following forms over, print up those you will need prior to our first session, including the Coaching Contract, Goals, Client Profile, and Coaching Preparation form and send them to me as email attachments to Please feel free to direct questions to that same address. You may also fax your completed forms to me at 360-344-2771.

Psychotherapy Forms

Intake Sheets with Map

Privacy Practice

Release of Records

Consent for Videoconferencing or Teletherapy

Emergency Plan (for video and teletherapy)

Coaching Forms

Intake Packet Checklist

Coaching Introduction

About Your Coach

Are you Ready for Coaching?

Client Profile

Coaching Contract

Coaching Preparation

Goals