Forms and Email Policy

You may print out these forms, fill out the requested information and bring with you to your first appointment. The forms are also available in the office.

  • Intake Form [doc]
  • Limits of Confidentiality Form [pdf] – This form should accompany the Intake Form and is also available in the office. It explains the limits of confidentiality in counseling.
  • Presentation Form – Required if you would like to request a counselor to speak to your group.

Email Policy

E-mail is not a confidential form of communication. In order to ensure confidentiality and protect your privacy, clinical services cannot be provided through email. Scheduling, confirming, and canceling appointments are also included. All clients are advised to contact the Office of Counseling and Testing by telephone or in person.


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100 E. University, Magnolia, Arkansas 71753-5000 Telephone: (870) 235-4000