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719-452-4803 contact@mayfieldcounseling.com

Helpful Forms

If you are a new client of Mayfield Counseling, please be sure to fill out the following forms.

Adults: Please print one Adult Intake Form for each person, fill it out, and hand-carry it to your intake session.

Adult Intake Form

Children & Adolescents: Please print one Child/Adolescent Intake Form for each person under the age of 18.  The parent or guardian is asked to fill out the first 10 pages, and the child or adolescent is asked to fill out the last 10 pages.  If the child is unable to fully complete his or her section, the therapist will review and complete it with the child during the session.  Hand carry both sections to your intake session.

Child/Adolescent Form



 719-452-4803  

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Our Location

1283 Kelly Johnson Blvd
Colorado Springs, CO 80920

Hours of Operation:

Monday - Friday: 8:00am - 8:00pm
Saturday: 8:00am - 4:00pm