Client Forms

Dear Survivors,

We have included this section in case you want to view our intake forms in advance of your scheduled counseling session. Please note that you are in control of what you choose to share with us -as much or as little information as you are comfortable with. We do ask that you pay particular attention to the Confidentiality, Non-Discrimination, Child Protection, and Services Agreement forms. We will fill them out with you and answer any questions you have at your appointment.

Please note that the Child School Release form is used if you would like us to provide services to your child (age 5+) at their school during the school day. We can also arrange for in-office child counseling or in-office babysitting during your counseling session with advance notice. Let us know what questions you have and we will do our best to answer.

Please remember that files you download on your devices might be seen by the abuser. If you suspect your devices are being monitored, we recommend you not download these documents.  

Remember, we believe you,
Your Phoenix Project Advocates

A Note About Accessibility Services

Phoenix Project will never turn anyone away because they do not speak English or have Limited English Proficiency. We have partnered with the Latinos in Virginia Empowerment Center to provide language interpretation for Spanish-speaking individuals. A link to their website can be found here: www.latinosenvirginia.org

For other Languages, including American Sign Language, we use Language Line Solutions.

Deaf/hard of hearing: We are a Virginia Relay Partner. Please access services by calling 711.

No Vision/Low vision clients: Our client intake forms are available in Braille. We have audio versions of our client intake forms available on our website.

Agency: Our Agency is wheelchair accessible.

Remember, we are here for you,
Your Phoenix Project Advocates