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Client Intake Forms

CLIENT INTAKE FORMS

Dear Client,

Thank you for choosing The Maple Counseling Center (TMCC). You have just taken a very positive step by deciding to seek counseling.  

TMCC began 1972 when a group of Beverly Hills parents became very concerned about the problems caused by teenage drug abuse.  Since that time, TMCC has evolved to become a comprehensive counseling center offering a range of services for the greater Los Angeles community.

An average of 550 clients are seen each week in individual, couples, family, and group therapy at TMCC’s headquarters office. Our psychiatry program offers medication evaluation and follow-up for clients who receive therapy at the Center. In addition, a range of ongoing therapy groups targeting different populations are available, and we encourage you to check the TMCC web site to see what groups are available at any time.

The Center recognizes the unique needs of older adults and their caregivers, and the importance of specialized programs for children, adolescents, and families. Services are provided  in our local schools, and in partnership with other community based organizations.  School based services include a volunteer driven Community Circle Program that facilitates groups in local elementary school classrooms, with the goal of promoting character, self-worth, responsibility, and to build strong communication skills.

TMCC’s intern training program attracts graduate students working toward licensure as psychologists, marriage and family therapists, clinical social workers, and professional clinical counselors from graduate programs in Southern California, along with schools throughout the United States. The Center has an excellent reputation for its intensive supervision and training curriculum.

The Maple Counseling Center is open to you regardless of where you live. Fees for counseling are on a sliding scale, based on your ability to pay,  and we ask that you provide proof of financial need. The cost of operations at TMCC is approximately 2 million dollars annually. In addition to the generosity of our donors, private foundations and municipal funding, client fees are important to help us keep the Center’s doors open.

We invite you to learn more about the The Maple Counseling Center. Feel free to ask your counselor about the many services available for you and your family.

We hope that your TMCC experience will be a positive one for you.

Warmly,

Marianne Callahan, PhD, LMFT
Clinical and Program Director

First please call our Intake line and leave a message, a counselor will give you a call back to direct you to correct intake form completion. 

Thank you

**For a couple’s intake session, please fill out two individual intake forms.

** Parents and Guardians, please fill out the Additional Counseling Information form for your child or adolescent who is seeking counseling.

Adult Intake Packet (Individual/ Couples)

Family/ Child or Adolescent Intake Packet

Group Intake Packet

Notice of Privacy Practices 

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