NICOLEE HILTZ, PHD
  • Home
  • About Me
  • Creative Interventions
    • Working One on One
    • Work with Couples
    • Couples Intensive
  • Appointment Request
  • Women: The Unfolding Story
Please Download and read the Introduction to Practice PDF; then Download and fill out the appropriate Intake form, HIPAA agreement, and email/text agreement. Don't forget to save this document so it can be e-mailed prior to your first visit.  Once all forms are filled out please email them to: tracypopalo.hiltzthiessen@gmail.com.
If you have any problems filling out these forms please contact my assistant, Tracy.
Introduction to Practice.pdf
File Size: 30 kb
File Type: pdf
Download File

Adult Intake Form.pdf
File Size: 311 kb
File Type: pdf
Download File

Child/Teen Intake Form.pdf
File Size: 1895 kb
File Type: pdf
Download File

Couples Intake Form.pdf
File Size: 1424 kb
File Type: pdf
Download File

HIPAA.pdf
File Size: 83 kb
File Type: pdf
Download File

Email and Text Agreement.pdf
File Size: 86 kb
File Type: pdf
Download File

Hours

By Appointment

Telephone

717-743-4223

Email

nicolee@couplesatcrossroads.com
  • Home
  • About Me
  • Creative Interventions
    • Working One on One
    • Work with Couples
    • Couples Intensive
  • Appointment Request
  • Women: The Unfolding Story