Everything you need to begin your journey with Samaritan Counseling Center
Below are the forms new clients need to fill out before receiving treatment at Samaritan Counseling Center. The forms are provided in both English and Spanish. Forms for Samaritan Center for Changing Families can be found below.
Please print, complete and bring your forms with you to your first appointment, along with your insurance card, drivers license and payment. If you need to drop the forms off ahead of your session, please secure them in an envelope to insure continued confidentiality.
Samaritan Counseling Center
1101 Medical Arts Avenue, NE
Albuquerque, NM 87102
New client packets
Program involvement forms
Samaritan Center for Changing Families Forms
If you plan to participate in Wise Parent Counseling, Mediation and other services provided through the Samaritan Center for Changing Families, you will need to complete the following packet.
- Samaritan Center for Changing Families new client packet
- Centro Samaritano de Consejería Para Cambios de Familia – Español
Cooperative Parenting Classes
The Samaritan Center for Changing Families offers Cooperative Parenting Classes for divorced or separated parents. Both parents are encouraged to attend Cooperative Parenting Classes as part of your commitment to child-centered parenting.
Authorization for Release of Information
This form, when completed and signed by you, authorizes Samaritan to release or acquire protected information concerning your clinical records from or to the person you designate.