Thank you for choosing TriCare Counseling & Consulting, Inc. to work with you and or your family. Select the appropriate form(s) below and complete.
Referral Form
We accept referrals for outpatient mental health clients and psychological testing. If we are unable to meet your need, we will suggest other providers we are aware of.
Intake forms
You will be able to sent a copy to yourself when complete. Please upload your ID and insurance card with the intake packet
Intake package (fillable online)
Intake package for clients with Medicaid (fillable online)
Symptom Scales
Parent/Guardian scale for children ages 6-17
Children scale for children self-report ages 11-17
Patient Health Questionnaire 9 (PHQ-9)
Life Events Checklist/PTSD Checklist-5 (LEC/PCL-5)
Other forms
Card Payment Consent Form (pdf fillable form)
Authorization for Release Of Information form (pdf fillable form)
If you have any questions feel free to call us at 910-249-4219