New Client Forms — Adults
You are seen. You are heard. This is where healing begins.
New Client — Adults 18 and Over
Start Here. These Are the Forms You Need.
Complete these five forms to begin. Each takes only a few minutes, and you do not need to finish them all in one sitting.
About the No Surprise Act notice further down this page: that is a separate federal notice for people paying without insurance. It is not a substitute for the five forms above, and completing it alone will not start your care.
Prefer to print and write by hand, or need a release form? Jump to all forms and PDF downloads.
Not sure which form applies to you? Email DrDarleen@orchardhumanservices.org and we will walk you through it.
Executive Director
Dr. Darleen Claire Wodzenski
MS ESE, MA CMHC, PhD, LPC, NCC, ACS
Licensed Professional Counselor in Florida, Georgia, and Virginia. Founder of Orchard Human Services, Inc., with more than 30 years of professional service in counseling, special education, and clinical mental health practice.
Orchard Is a Space Where You Can Relax, Grow, and Heal
Every person who comes to Orchard arrives with a story. Some stories carry the weight of old wounds. Some hold dreams not yet spoken aloud. Some are tangled in the middle — seeking clarity, looking for the next right step.
Wherever you are on your path, you do not have to arrive “ready.” You only have to arrive.
We meet you where you are — and walk with you toward who you are becoming.
The Work We Do Together
Six Paths of Growth & Healing
Orchard’s adult clinical work honors the whole person. You may arrive for one concern and discover the path winds through others. That is not detour — that is healing.
Path One
Working Through Trauma
Trauma lives in the body, in memory, in the quiet places we have learned to avoid. Orchard offers evidence-based, trauma-informed care — including the Fluid Trauma® protocol developed here — so the past no longer rules the present.
Path Two
Supporting Personal Growth
Growth is rarely a straight line. Together we examine the patterns that no longer serve you, strengthen the ones that do, and build the skills — emotional literacy, regulation, self-awareness — that allow you to move forward with intention.
Path Three
Spiritual & Philosophical Exploration
Meaning matters. Whether your path is traditional, eclectic, questioning, or quiet, Orchard holds space for the deeper questions — purpose, faith, identity, connection to something larger than ourselves.
Path Four
Family & Relationships
We are shaped by our attachments — the people who raised us, the people we love now, the patterns we carry forward. Orchard helps you understand these bonds, repair where possible, and build relationships that nourish rather than deplete.
Path Five
Work & Career
Your work is not all of who you are — but it shapes your days, your energy, your sense of contribution. We address burnout, purpose misalignment, workplace stress, and the deeper question of whether your working life reflects what you value.
Path Six
Self-Determination & Life Satisfaction
You are the author of your life. Orchard helps you reclaim that authorship — clarifying what you want, honoring what you need, and taking the aligned, sustainable actions that lead to a life you are genuinely glad to be living.
We Meet You Where You Are
Some clients know exactly what they want to work on. Others arrive with only a feeling — a heaviness, a hope, a question without words. Both are welcome. Both are enough.
Your intake forms are the beginning of your story here. Take your time. Share what you can. The rest will unfold in the room, in the conversation, in the quiet work of being truly seen.
All Adult Forms
Everything available on this page, in the order most people need it.
This page is for adults 18 and older. If you are seeking services for a child under 18, please visit the forms page for minors.
Required for Everyone
1. New Client Intake Forms
Complete online, or print and return by fax or email. Online is faster.
Complete online
Adult New Client Form
HIPAA Privacy Form
Telemental Health Permission Form
Appointment Policy
Consent for Third Party Billing — only if insurance is paying
Or download and print
Adult New Client Form (PDF)
HIPAA Privacy Form (PDF)
Telemental Health Permission Form (PDF)
Consent for Third Party Billing (PDF)
Return completed PDFs to Forms@OrchardHumanServices.org or fax to (877) 660-8884.
Only If It Applies to You
2. Guardian or Authorized Person
If you are the guardian of an adult, or an adult authorizing another person to be involved in your care.
Self-Pay Clients Only
3. No Surprise Act Notice & Consent
This applies only if you are paying for care without insurance. Federal law gives you the right to know what your care will cost before it begins. This does not replace the intake forms above.
Complete the Notice & Consent online
Disclosure Statement (PDF)
Full Notice & Consent packet (PDF)
Only If It Applies to You
4. Release Forms
To let us share information with a doctor, another provider, or a school.
Authorization & Release Form — doctors, providers, individuals
FERPA Release Form — school, college, or university
Free Resources
5. Self-Care Guide and Clinical Tools
Self-Care Guide (PDF) — a thin book to help you through a rough patch. Free to download, free to share.
Clinician Companion Tool (PDF)
The companion tool is designed for guided use with your Orchard clinician during a session, not for working through on your own. If you need support right now, please use the crisis resources below.
Fees, insurance, and low-cost options are set out on the fees page, or ask our staff and we will talk it through with you.
If You Need Help Right Now
Orchard is not a crisis service. Call or text 988 for the Suicide and Crisis Lifeline, or 911 if someone is in immediate danger.
For a confidential text with crisis resources and referrals, call (888) 263-1986 and our system will text you back. We only respond to your request.
Orchard Human Services, Inc.
An IRS-approved 501(c)(3) nonprofit organization, uplifting lives by counseling, educating, and caring.
DrDarleen@orchardhumanservices.org
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