Client Forms

If you are new, please be sure to fill out the following forms, and bring them to your first session.

Forms

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information

This will help ease you in and allow as much time as possible to focus on you.
Rosemarie Wheeler

Client Intake Form

Download and fill out the form below

Information Sheet

Download and fill out the form below

Limits of Confidentiality

Download and fill out the form below

Get In Touch

Call

(951) 466-7589

Tipton County, Tennessee
License #1883
Licensed in California
License #105045

Address

Burlison, TN

Verified by Psychology Today

Hours

Mon. 9-5 • Tues. 9-4
Wed. 9-6 • Thurs. 9-6 • Fri. 9-4
Evening Appointments available – by request only
Closed Weekends