Open Doors Counseling, Coaching and
Consulting
18444 N. 25th Ave.
Suite 420
Phoenix, AZ 85023

Phone 602-499-9952

admin@opendoors
counselingaz.com

Helpful Forms

Below are links to helpful forms that you will be asked to bring or complete at your first counseling or coaching session.

Initial Assessment
The initial assessment is used to help our therapist gather a history to learn more about you and help determine the best way to assist you in achieving your goals for change.
Open_Doors_Initial_Assessment.docx
16.9 KB


Consent to Treatment Form

This form allow you to be informed about your treatment and give your consent to receive services from our therapist.
Generic_Consent_for_Treatment_7.2016.docx
13.4 KB


Insurance Information Form
If you would like to use your insurance to help pay for your counseling services, please complete the below form.
Insurance_Information_Form.docx
11.3 KB


Payment Agreement Form
This form reviews the service fees and payment policies.
Service Payment Agreement 10.2016.docx
16.8 KB



Release of Information Form
If you would like another party to have access to your service information, like an insurance company or doctor, please fill out the form below to authorize Open Doors Counseling, Coaching and Consulting to release your information.
Release_of_Information.docx
11.1 KB


 

Open Doors Counseling, Coaching and Consulting is located in Phoenix, Arizona and serves the cities 
of Phoenix, Glendale, Paradise Valley, Peoria, and Scottsdale.
Services include counseling, psychotherapy, therapy, coaching, life coaching, 
couples counseling, consulting and clinical supervision.
Services are provided by Kelly Gutowski, Licensed Clinical Social Worker .
License Number Arizona LCSW12929.
Open Doors Counseling, Coaching and Consulting was founded in 2012.
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