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If you are meeting with me for counseling at Bethlehem Counseling Associates, please arrive 10-15 minutes early to fill out intake forms or download forms here and bring completed forms to your first session. 

If you are meeting with me for counseling sessions with a major focus on yoga therapy, please print out and fill in the following prior to our first meeting:



Except in certain instances, which are covered in the Informed Consent Form (see above) and which we will discuss in our first session, I must have your written permission in order to share information with a third party. In the event we decide together that it is in your best interests for me to speak with another party, I will provide you with the following forms:


  • Release of Information From Janice (to a third party)

  • Release of Information To Janice (from a third party)

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