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Todd Shirley, LPC

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Forms

New Client

LPC near meBefore our first session, please download, complete, and email back the following form. If you don’t have a scanner, just take a picture of the forms with your phone and email it to me as a picture.

Professional Disclosure Statement Form

Evaluation

Depending on your needs, I may suggest you complete a Behavioral Health Evaluation. This form evaluates many aspects of your life, and includes a number of validated assessment measures that can offer valuable insights into the nature of your life challenges. Remember that all your answers are covered by our confidentiality agreement, so be as truthful as you can when completing the form.

Behavioral Health Evaluation Form

Attachment Based Family Therapy

If you’d be willing to be recorded for Attachment Based Family Therapy supervision, please read and sign this consent form below.

Video/Audio Consent Form

 

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Todd Shirley is a teen and family counselor in Malvern and Wayne, PA. He specializes in working with teens struggling with anxiety and depression.

Contact Information

Todd Shirley, LPC
toddshirleycounseling@proton.me
610-947-4211

Copyright  ©2024

 

Resources

  • About Me
  • Forms
  • Fees
  • FAQ
  • Testimonials

Services

  • Teen Therapy
  • Individual Therapy
  • Couples and Family Therapy
  • Teletherapy
  • Free Consult