Forms – Adult

Welcome to Orchard

You are seen. You are heard. This is where healing begins.

Dr. Darleen Claire Wodzenski, Executive Director
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.

Adult Intake Forms

When you are ready, the forms below prepare us to serve you well. Choose the option that feels easiest — online fillable forms or downloadable PDFs.

This page is for adults 18 years of age and older.
If you are seeking services for a minor child under 18, please visit the Forms for Minor/Child page.

Section A

No Surprise Act Notice

You have rights as a client. Orchard Human Services, Inc. complies with the 2022 No-Surprise Act to the extent allowed by law and ethical standards of practice. Please review the forms below, and feel free to ask our staff about this important law.

Fees are discussed on the counseling page, or ask staff for more information.

Need help accessing the forms? Call or email our staff for assistance at
(770) 686-0894  ·  Appointments@OrchardHumanServices.org

Section B

Self-Care Guide — A Companion For Rough Patches

A thin book to help you through a rough patch in life. Free to download, free to share, written with you in mind.

Click here to download the free Self-Care Guide (PDF)

Section C

New Client Forms for Adults

You have two options for completing new client intake:

  1. Online Fillable Forms — complete online, sign, and submit
  2. Downloadable PDF Forms — print, complete by hand, then fax or email back

If You Are a Guardian of an Adult — or an Adult Authorizing Another Person in Your Care

Returning PDF forms: Email completed forms to Forms@OrchardHumanServices.org or fax to 877-660-8884.

Section D

Authorization & Release Form

To authorize Orchard Human Services, Inc. staff to share information with a doctor, provider, or other individual, please complete this form with your signature and date.

Click here to complete the Authorization & Release Form

Section E

FERPA Release Form

To authorize Orchard Human Services, Inc. staff to speak with your school, college, technical school, or university, please complete the FERPA Release Form.

Click here to complete the FERPA Release Form

Section F

Additional Clinical Resources

Supplemental materials available to your Orchard clinician for use within active therapy.

Clinician Companion Tool (PDF)

These resources are intended for guided use during therapy sessions with your Orchard provider, not for independent self-administration. If you are in crisis right now, please use the confidential resources in the section below.

Fees are discussed on the counseling page, or ask staff for more information.

Crisis Resources — Confidential Text-Back

Want to receive a text with crisis resources? Call the number below and our system will automatically send a text with crisis resources, referrals, and other valuable information.

(888) 263-1986

Your information is confidential. We only respond to your request for resources.

Orchard Human Services, Inc. — Uplifting Lives By Counseling, Educating & Caring.

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