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info@shininghopecounseling.com
(817) 668-6789

Shining Hope Counseling

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Client Forms

If you are new, please be sure to fill out the following forms, and bring them to your first session. This will help ease you in and allow as much time as possible to focus on you.

Client Intake Form

Information Sheet

Limits of Confidentiality

HIPAA

If you would like me to collaborate with someone else about your care such as a physician, another mental health provider, attorney, etc., simply fill out the following form.

Authorization for Release of Information

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Shining Hope Counseling

Mary Keyhan bio photo | Shining Hope Counseling | Therapist | Southlake, TX 76092

(817) 668-6789
info@shininghopecounseling.com

771 E Southlake Blvd, Suite 104 Southlake, TX 76092


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Mary Keyhan, PhD

Licensed Professional Counselor Licensed Marriage and Family Therapist  

(817) 668-6789
info@shininghopecounseling.com


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"You don't have to see the whole staircase, just take the first step."
-Martin Luther King

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