Office Phone: 513-770-3231

Deerfield Twp. Family Counseling

Deerfield Twp. Family CounselingDeerfield Twp. Family CounselingDeerfield Twp. Family Counseling

Deerfield Twp. Family Counseling

Deerfield Twp. Family CounselingDeerfield Twp. Family CounselingDeerfield Twp. Family Counseling
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    • Home
    • About
    • Forms
    • Contact Us
    • Make A Payment
  • Home
  • About
  • Forms
  • Contact Us
  • Make A Payment

Deerfield Twp. Family Counseling

Intake Forms

After you have scheduled your initial appointment, watch your inbox for required intake documentation.


If you need for us to contact anyone on your behalf, your child's behalf, or if you are involved with the court in any manner, please complete the Release of Information forms below.

Questions?

If you have any questions about the forms or the intake process, call our office phone 513-770-3231 during business hours.


If you are able to fill out the forms on the computer, you may email them to us at:  intake@deerfieldtwpfamilycounseling.com

Release of Information

If you need for us to contact anyone on your behalf, your child's behalf, or if you are involved with the court in any manner, please complete the form below.

Release of Information (pdf)Download
Release of Information Child (pdf)Download

HIPAA

The form here is to advise you of your HIPAA rights.  You do not need to bring this form in with you.

HIPAA explanation (pdf)Download

HIPAA

Notice of Privacy Practices

The form here is to advise you of your HIPAA rights.

You do not need to bring this form in with you.

Download PDF

Copyright © 2026 Deerfield Twp. Family Counseling - All Rights Reserved.


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