Chapin Faulconer
Licensed Professional Counselor
Chapin Faulconer
(434) 996-6362
1 Boars Head Place
Charlottesville, VA 22903
chapinrf@gmail.com
Helpful Forms

If you're a first-time client, please review and complete the following forms and bring them to your first session.

  • Client Intake Form
  • Notice of Privacy Practices

 

If you would like me to coordinate care with another provider (for example, your psychiatrist, family practitioner, etc.), complete this form:

  • Consent to Release Information Form

 


Consent to Release
Intake Form
Notice of Privacy Practices

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