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Kelly Casparius | www.beaconofhopenc.com

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Client Forms

Please read the following Information Sheet document before filling out our Client Intake form. This document outlines the following items for your information:

  • Consent to Counsel Information
  • Qualifications and Populations Served
  • Therapy Approach
  • HIPPA Privacy Information

Information Sheet

Client Intake Form

Limits of Confidentiality

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

Kelly Casparius

MA, LCMHC, NCC, RPT

 

 
910-859-8166
beaconofhopenc@gmail.com

5041 New Centre Ave
Suite 112
Wilmington, NC 28403

Beacon of Hope Counseling

 
910-859-8166
Fax: 910-920-9878
beaconofhopenc@gmail.com
 

5041 New Centre Dr,
Suite 112,
Wilmington, NC 28403

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