Canandaigua Lake Counseling Services

Move toward a richer, more rewarding life.

Forms: 

In order for us to provide the best possible counseling services to you, certain information is important for us to know. This is why your privacy is a priority to us at Canandaigua Lake Counseling Services. The following forms provide us with some of that information, while protecting your privacy and letting you know of your rights. Please review these forms prior to your first session. 


If you have access to a printer, please bring a completed copy of the indicated "Intake Packet" to your first session. If not, the administrative assistant will provide you with a copy to sign upon your arrival. If you do not fill these forms out ahead of time, please try to arrive 10-15 minutes early to your first session.



If you have any questions about your privacy, our policies, or your rights, please contact us


PDF Forms:

CLCS Adult Intake Packet

        *Please complete this form if you or your child is 16 years of age or older. If you or your child is under 18 years old, a parent or guardian              must sign the Billing and Disclosure Document. 


CLCS Child Intake Packet

          *Please complete this form for your child if he/she is under 16 years of age.


CLCS Notice of Privacy Practices (HIPAA)

        *Please review this information, and sign where indicated on the Billing and Disclosure Agreement in the Intake Packet stating that you                 agree to these terms.