Please download and print the files on this page after scheduling your initial couples counseling appointment with your therapist. Be aware that using medical insurance for couples work is like putting a round peg into a square hole.  Medical insurance is geared for an individual medical chart, NOT A MUTUALLY OWNED MEDICAL CHART. That means that to use medical insurance, only one person will own the medical chart and control it’s information.  We recommend that the insured person set up the chart and complete most of the forms. The informed consent is to be completed by the spouse of the insured and theshared information authorization form will need to be completed by both of you.  We also that ask that the spouse of the insured person also complete his/her own safety questionnaire.

Scan all your images including the front and back of your insurance card and your drivers license.  Scan into ONE continuous pdf file (Adobe Scan can do this easily)

Submit your pdf file with the secure file transfer mechanism at the bottom of this page. Alternatively you can snail-mail the documents to our office:

Cary Counseling Center

875 Walnut Street Suite 275

Cary, NC 27511

Couples Registration

Service Agreement

Informed Consent (completed by spouse)

Shared Information Authorization (completed by both partners)


Safety&Symptoms  (completed by both partners)

Please print 2 copies of the Safety & Symptoms form to be filled out by both partners

Please use the following file transfer mechanism if you choose to send files over the internet to your therapist. DO NOT USE REGULAR NON-SECURE EMAIL. Attach your file(s) at the very bottom and make sure you add your therapist’s name in the comments section to assist our routing.