Client Forms


New clients will need to fill out several forms before therapy can begin. To make the process as smooth and efficient as possible, we provide the most important documents as downloads right here on our website.


Find out which forms you need to submit, select the appropriate download link and return the completed documents to our practice either in person or as a scanned PDF file via e-mail. Naturally, all forms are also available at the office; however, filling them out in advance saves time.

If you are unsure which forms to fill out, don't hesitate to contact us.

Adult Intake Form
A brief snap-shot of you. It provides Moriah Counseling with some important information about your mental, physical, historical, etc. status.
Moriah - Adult Intake Form.doc
Microsoft Word document [1.2 MB]
Child Intake Form
A brief snap-shot of your child. It provides Moriah Couseling with some improtant information about your child. PARENT/GUARDIAN PLEASE COMPLETE THIS FORM.
Moriah - Children's Intake Form.doc
Microsoft Word document [1.0 MB]
Client Information Form
This form provides us with necessary contact information about you, where to call and how to leave messages. It also ask for emergency contact information.
Moriah - Information Form.doc
Microsoft Word document [922.0 KB]

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.

Where to Find Us:

MAIN Office Location

10983 State Road

North Royalton, OH 44133

MEDINA Office Location

2325 Medina Road

Medina, OH 44224


At the GRACE CHURCH (Medina East Campus)

Mailing Address

P.O. Box 33526

North Royalton, OH 44133






MAIN Office Hours

Monday: Closed
Tuesday: 9a to 8p
Wednesday: 9a to 8p
Thursday: 9a to 8p

9a to 4p

Saturday: 9a to 11a


MEDINA Office Hours

Wednesday: 10a to 3p
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