Forms – Minor/Child Under 18

COUNSELING FOR MINORS
Dr. Darleen with young people engaging in play therapy, games, therapeutic library, and digital connection

From puppets and play to games and growth — we meet each young person exactly where they are.

Welcome, parents and caregivers.

Seeking professional support for your family is a meaningful decision, and we honor the care and thoughtfulness that bring you here. Your young person will be met with warmth, clinical skill, and deep respect for their stage of development.

When a teenager reaches adulthood, they can continue independent clinical care with a therapist who already knows their story.

How We Approach Therapy

A developmentally-informed, relationship-centered framework

Developmentally-Informed

Every stage of development calls for a different approach. We meet each young person at their level, using play-based strategies with our youngest clients, creative and experiential methods mid-range, and a more collaborative therapeutic relationship as maturity develops.

Attachment & Relationship-Centered

Healing happens in safe relationships. Our therapists take the time to build genuine trust with each client, because we know that the therapeutic relationship itself is the most powerful tool we have. Dr. Darleen specializes in attachment-informed care, which shapes every aspect of how we support young people navigating life’s challenges.

Brain-Based & Informed

“Behavior” is often a window into how the brain and nervous system are responding to stress or developmental demands. Rather than simply managing symptoms, we work to understand the underlying causes and teach the skills that help young people regulate, connect, and thrive.

Family-Involved

Parents and caregivers are partners in the healing process. We keep you informed, coach you through challenges, and support the whole family system. Growth happens within the loving relationships that surround each young person.

Ready to begin? We’re honored to walk with you.

Complete the New Minor intake form to get started, or email us first if you have questions.

Start Intake Form →
A joyful young child on green grass showing painted smile faces on both hands

What We Help With

Specialized clinical care across neurodevelopmental, emotional, and relational needs

Neurodevelopmental

Autism Spectrum Disorder (ASD, Asperger’s) · ADD & ADHD · Sensory Processing Disorder · Intellectual Disability · Traumatic Brain Injury · Learning Problems · Memory Challenges · Focus & Attentional Challenges

Attachment & Complex Needs

Reactive Attachment Disorder (RAD) · Disinhibited Social Engagement Disorder (DSED) · Complex Presentations · Developmental Needs · PTSD · Adoption & Foster Care transitions

Mood & Anxiety

Bipolar Disorder · Depression · OCD · ODD · Anxiety & Fear

Severe Symptoms & Safety

Dissociative Disorder · Eating Disorder · Self-Regulation Challenges

School & Learning Support

IEP & Section 504 Plan Advocacy · Learning Disabilities · Academic Performance · Behavior & Classroom Challenges · Autism Socialization · Following Rules & Paying Attention

Five happy young people sitting together outdoors in soft sunlight
PARENTS ARE PARTNERS

Your Role in the Healing Process

We believe that parents and caregivers are essential partners in therapeutic work. You know your young person better than anyone — your insights, observations, and care are irreplaceable.

Expect to be included: parent meetings, progress updates, practical strategies to use at home, and support as you navigate this meaningful work together.

IMPORTANT FOR CUSTODY SITUATIONS

Court-Ordered Custody Arrangements

If custody has been determined by court order, please submit a copy of the Court Ordered Custody Agreement with Parenting Plan before the first appointment. This ensures we have appropriate permission to provide services and honor the legal framework protecting your family.

Our staff can answer any questions about this requirement. Email Forms@OrchardHumanServices.org.

NEW CLIENT INTAKE

Intake Forms

Everything you need to begin, all in one place

EASIEST — START HERE

Quick Form — All-in-One Intake

Complete the intake in one seamless process. You may be asked to upload additional information separately.

» Start the New Minor Quick Form

» Complete the Appointment Policy

ALTERNATIVE — ONE AT A TIME

Individual Online Fillable Forms

Complete each form individually for more comprehensive information.

Only if you cannot use the online fillable forms

Download, print, complete by hand, then fax to 877-660-8884 or email to Forms@OrchardHumanServices.org

SELF-PAY FAMILIES ONLY

No Surprise Act Notice & Consent

Required if you do NOT have insurance paying for care

The No Surprise Act applies to families paying for care directly, without insurance. Federal law requires that you receive this notice and consent.

STEP 2 — DOWNLOAD BOTH DOCUMENTS

Everyone completing Step 1 must also download these for their records:

Disclosure Statement (PDF)

Full Notice & Consent Packet (PDF)

Additional Releases (As Needed)

Use these in addition to your intake forms

Authorization & Release Form

Authorize Orchard staff to share information with your pediatrician, school, or other provider.

» Complete the Authorization & Release Form

FERPA Release Form (For School Communication)

Authorize Orchard staff to speak directly with schools or teachers.

» Complete the FERPA Release Form

CRISIS SUPPORT

If you or a family member is in danger or crisis, please call 911 or go to the nearest emergency room immediately.

For non-emergency resources, call (888) 263-1986 and our system will text you support resources, referrals, and information. Your information is confidential.

We’re honored to walk alongside your family.

Each client is met with care, skill, and deep respect.

Or email us first with any questions:

Forms@OrchardHumanServices.org

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

Comments are closed.