New Client Intake Forms | Rachel Moskowitz, LMHC — Orlando
New Clients

Welcome — let's get you started.

To make the most of your first appointment, please complete the intake packet beforehand. It takes about 10–15 minutes and helps Rachel understand how best to support you.

New Client Intake Packet

Download, print, and complete the packet, then email the signed forms to Rachel before your first appointment. If you'd prefer to provide the forms another way, just call the office.

⇣  Download Intake Packet (PDF)
PDF · 5 pages · Includes client information, informed consent, health history, and appointment policies
1

Download & Print

Open the PDF above and print all pages.

2

Complete & Sign

Fill out each section and sign where indicated.

3

Email It to Rachel

Send your completed packet to [email protected] — a secure, confidential inbox.

Before You Begin

What to know about working together

These policies are included in the packet. Reviewing them ahead of time helps your first session go smoothly.

Informed Consent for Treatment

Psychotherapy and counseling vary depending on the personalities of the counselor and client and the particular concerns you bring forward. Unlike a typical medical visit, you'll be an active participant in the process, working both during and between sessions.

Therapy can have both benefits and risks. Because it can involve discussing difficult aspects of your life, you may at times experience uncomfortable feelings. At the same time, counseling has been shown to bring meaningful benefits — stronger relationships, solutions to specific problems, and real reductions in distress. There are no guarantees about what you'll experience, but you'll be involved in setting your treatment goals, and those goals are reviewed regularly throughout your care.

Your privacy and confidentiality are strictly maintained, except where you provide written permission to disclose, or where the law requires it. Limited exceptions include situations involving danger to self or others; suspected abuse of a child, elderly person, or someone unable to protect themselves; a court order requiring release of information; matters of national security; or a referral from worker's compensation.

Some routine disclosures may occur in the normal course of care — for example, confirming appointments, consulting with a supervisor or colleague, or coordinating with an insurance or financial intermediary during billing. Your signature on the packet provides permission for these.

You are financially responsible for all charges, and it is your responsibility to confirm your benefits, out-of-pocket costs, and potential reimbursement with your insurance company. All fees are due at the time of service.

Cancelled, Rescheduled & Phone Session Appointments

Clients who cancel or reschedule with less than 24 hours' notice are responsible for the full fee for the time reserved. Exceptions may be made for extenuating circumstances at the counselor's discretion.

If a situation requires a phone session lasting more than 15 minutes, it will be charged at the rate of a regular therapy session.

To avoid unnecessary charges, the packet asks you to keep a card on file that can be charged for missed or late-cancelled appointments. For your security, card details are collected and stored only through a secure payment process — never by email or web form.

Questions before your first visit?

Rachel is happy to answer anything before you begin. Reach out any time — your inquiry goes directly to her.

© 2026 Rachel Moskowitz, LLC · (407) 906-0565 · [email protected]
Licensed Mental Health Counselor · FL Supreme Court Certified Family Mediator
Casselberry: 142 Wilshire Blvd., Casselberry, FL 32707  ·  New Smyrna Beach: 629 N Dixie Fwy, New Smyrna Beach, FL 32168