Estar Counseling Services, Inc.
Therapy for Individuals, Couples, & Families
Estar Counseling Services, Inc.
D. Paul Rodriguez, Ph.D.

P.O. Box 6728
North Port, FL 34290

Office phone: 941.685.8654
Fax: 941.876.3452

estarcnsvs@hotmail.com
Forms
If you're a new client, please complete the following forms and bring them to your first therapy session.

Demographic Information



Consent for Treatment



Notice of Privacy Practice



Client Psychotherapy Intake Form



L imits of Confidentiality/Therapy Cancellation Policy
 



Substance Abuse Forms:

Drug Testing Consent

 

DAST



MAST



Client Self Report1



Client Self Report2


If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Authorization to Disclose Information Form




Note: To download Adobe Acrobat Reader for free, click here.