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The Owen Center Personal Profile Form – Children and Adolescent (6-17)

  • Counseling Agreement

  • Before you enter your information, please take a moment to view the counseling agreement. To read over the agreement CLICK HERE. By selecting “Yes” in the following question, you acknowledge that you have read over and agree with the Counseling Agreement. If you have any questions about this, please call our office or email us at office@theowencenter.com.
  • – You understand the counseling agreement. – Your counselor is obligated by state law to report any incidents of suspected or obvious child abuse or neglect. – Your counselor may ask your permission for another counselor/prospective counselor to sit in a session. – Your counselor might be required to divulge information to appropriate civil authorities if there is an indication that you or someone else might otherwise be harmed or be at risk of abuse or neglect.
  • Personal Information

  • MM slash DD slash YYYY
  • “___ of ___ children”
  • In order for counseling to be effective, your counselor may meet with your child alone or include you in sessions at the counselor’s discretion. If your child is in a counseling session without you, you MUST wait in the waiting room for the duration of the session. By selecting yes, you understand and submit to this protocol and the counseling agreement.
  • This field is for validation purposes and should be left unchanged.