Audra York, MS, LPC-S, RPT-S
Audra York Therapy, LLC
4141 B Street
​Suite 301
Anchorage, AK  99503
Phone: (907) 952-8532
  • Home
  • About Me
    • Certifications & Therapy Modalities
  • Services Provided
    • Trauma-Informed Approach
    • Play Therapy
    • LGBTQ+ Services
  • Forms
  • Contact Me & Directions
  • Rates & Insurance
  • Privacy & Policy
  • Recommended Readings
  • Links & Resources
  • Inspiration

Forms

Picture
*in process of updating forms and the address on the forms to current location (4141 B Street, Suite 301)
​
Below you will find some helpful forms. You will need Adobe to open and read the pdf documents. Please bring them to our first session and I look forward to meeting with you. I will also have copies available when we meet if needed. 

Please call me with any questions at (907) 952-8532.

Please complete forms/questionnaires with your legal name and gender information, there is a space for a preferred name or a nickname. 
*Reminders-- Cash or Check only for co-pays and deductibles. Only primary insurance will be billed (I do not bill a second or a third insurance) Jan. 2019

INTAKE QUESTIONNAIRE FOR FIRST APPOINTMENT:   ​
child_intake_questionnaire.pdf
File Size: 101 kb
File Type: pdf
Download File

adult_intake_questionnaire_updated_11.2019.pdf
File Size: 68 kb
File Type: pdf
Download File

ADDITIONAL FORMS:
release_of_information_and_records_authorization__roi_.pdf
File Size: 64 kb
File Type: pdf
Download File

FORMS AND INFORMATION FOR YOUR RECORDS: 
hippa_notice.pdf
File Size: 41 kb
File Type: pdf
Download File

www.audrayorktherapy.com
Picture