Counseling Forms
These are the forms that are required to begin services.
If you are a new patient please choose either the adult packet for all persons 18 and over and child packet for all persons 18 and under.
Once you have completed these forms, please call us at 502.444.Life (5433) to schedule your appointment or send us an email to
Our Fax number is 502.535.2618
Office Hours
Monday through Thursday - 9 am until 3 pm
Friday - 10 am until 2 pm
Saturday & Sunday - Closed
In order to be seen by our psychiatric mental health nurse practitioner (PMHNP) a referral must be submitted by your Life In Motion Therapist. You may complete these forms first but you can not schedule until we receive the therapist's referral. Appointments are scheduled in the order we receive these forms.