MDCS New Client History & Privacy Practices Forms (Adult)

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Welcome to Maria Droste Counseling Services! We hope this form will help expedite starting the therapy process, as we've made it easy to complete and submit it electronically even before arriving at our offices. The information you provide will allow your therapist to learn more about your background ahead of time.

ATTENTION: This form is meant for new clients with confirmed appointments. If you have not yet completed an over-the-phone intake with one of our staff, please do not complete this form. Please call us at 617-471-5686 for an intake. Thank you!

Consent to participate

PLEASE READ: Maria Droste Counseling Services (MDCS) uses your information for our internal statistics to help shape our future programming. Any and all data used will remain completely anonymous. We will never share you or your child’s information with any third parties unless requested by you and in compliance with our policies.

We do share aggregate summaries with others for the purposes of outreach and improving our services, which does not include your individual responses to any questions or any identifiable information about you. For example, we may share a statistic such as the following: 56% of clients are female.

Please speak with your therapist if you have any questions or concerns about this statement.

Please affirm that you read the above notice. *

I read, understand, and consent to the information stated above.

I understand that my information will remain confidential, yet I prefer that my information is not counted in external statistics and aggregate summaries.

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