First session forms

Please click on the appropriate LINK below to print your paperwork.  

Please note: 

If you are scheduling for someone you have legal care of, Current Custody or Power of Attorney  documents are required before scheduling.  This helps us to appropriately determine consent for care and access to confidential information. Please submit the full document to the Client Registration office at 330-915-2364 or intake@emerge.org


Please click HERE to read EMERGE Counseling Service's NOTICE OF PRIVACY.


Adult client

Please click HERE to download the Adult Health History form. Please print and fill out the form for your first appointment.  Forms can be faxed to 330-915-2364, emailed to intake@emerge.org, or mailed to EMERGE Counseling Services, 900 Mull Ave., Akron, OH 44313

If you are unable to print the forms and your appointment is at the Akron office, you may come 1/2 hour prior to your appointment to complete the paperwork on-site.  


Please click HERE to read EMERGE Counseling Services' NOTICE OF PRIVACY

minor client

Please click HERE to download the Minor Client Health History Form. 


Please print and fill out the form for your first appointment.  Forms can be faxed to 330-915-2364, emailed to intake@emerge.org, or mailed to EMERGE Counseling Services, 900 Mull Ave., Akron, OH 44313

If you are unable to print the forms and your appointment is at the Akron office, you may come 1/2 hour prior to your appointment to complete the paperwork on-site.  


Please click HERE to read EMERGE Counseling Services' Notice of Privacy.





previous minor client

Please click HERE to download the Health History Form for a returning minor client. 


Please print and fill out the form for your first appointment.  Forms can be faxed to 330-915-2364, emailed to intake@emerge.org, or mailed to EMERGE Counseling Services, 900 Mull Ave., Akron, OH 44313

If you are unable to print the forms and your appointment is at the Akron office, you may come 1/2 hour prior to your appointment to complete the paperwork on-site.  


Please click HERE to read EMERGE Counseling Services' Notice of Privacy.