Intake Information
See below to identify all documents required to begin services. Once all the appropriate documents have been received, an evaluation appointment may be scheduled. Please contact the office at 801-542-7060 to schedule appointments.
All first time appointments will require a $60 deposit at the time of scheduling.
Voluntary Therapy
documents required before evaluation:
Client Portal Creation and Completion of Application
Please email the following to info@changescounseling.org:
Copy of Photo ID
Copy of Insurance Card (if applicable)
Court-Mandated Services
Documents required before evaluation:
For court-ordered clients, Changes Counseling Policy and Procedure requires a Release of Information form to be signed, which allows us to include and communicate with reporting agencies, such as your probation officer, the court, or a judge.
Add any needed reporting agencies (PO, attorney, courts etc.) to your “related contacts” when filling out the application
Please email the following to info@changescounseling.org:
Criminal History Report
Police Report and/or Discovery
Copy of Photo ID
Copy of Insurance Card (if applicable)
Intake Packets
Changes Counseling is a proud Medicaid provider. Private pay and most insurance companies are also accepted. It is recommended to contact your provider to identify if treatment is within network. Please select the appropriate intake packet below, complete it, and return it to the office via email or in person.
Print & Handwrite
Electronic Entry
Release of Information
For updates to your release of information, please complete the document below. This allows office personnel and therapists to provide reports or discuss your case with the listed partiesor. Once filled out and sign, please email back to changescounseling.org. This can also be updated in the client portal with assistance from office personnel.