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It is truly my honor to be serving as your Mental Health Therapist. These forms help ensure that you are receiving the best care possible as we move forward with treatment.

Before your first appointment please print, review and complete the following documents:
(click on the title of each document to upload the pdf form)

  1. Client Information Form - to be printed, completed and returned to counselor.
  2. Disclosure Statement to be printed, reviewed and signed.
  3. Colorado Notice Form of HIPAA Legislation - to be printed, reviewed and signed.
  4. If receiving couples counseling:  Couples Consent Form

**Please retain a copy of this information for your records.  If you are unable to print off these documents please let Shannon know and she will provide you with a packet in person or via mail.

Bring ALL forms to your first appointment or mail them to:

ATTN: Shannon Rants, MA, LPC
P.O. Box 147 Canby, OR 97013