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
License #1883
Licensed in California
License #105045
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