Well Counseling Services, LLC.

Rev. Marcos Ghali, M.A., LPC/CR
Licensed Professional Counselor

5677 Mahoning Ave.
Austintown, OH 44515

Call: 330.507.8044
Fax: 440.871.7545

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Documents

To get started, please print and complete the documents below and bring with you to the initial appointment. The purpose of these documents is to protect your rights and privacy and to provide you with the essential information you need to get started. Read them carefully before signing and during your initial visit, we will explain in detail every document and how to better protect your confidentiality.

Documents to complete and bring to first appointment:
Download the PDF documentIntake Form
Download the PDF documentClient Information Sheet
Download the PDF documentInformed Consent
Documents for you to keep:
Download the PDF documentHIPPA Client Rights
Download the PDF documentHIPPA Notice of Privacy Practices
Download the PDF documentProfessional Disclosure Statement
Download the PDF documentFee Schedule
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