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Client Intake Forms


Dear Client,

You have just taken a very positive step by deciding to seek counseling. We are happy that you have chosen The Maple Counseling Center (TMCC) and want to take a moment to tell you a little about this remarkable nonprofit agency.

We opened in 1972 when concerned Beverly Hills volunteers began working on the problems caused by teenage drug abuse. Now we are considered one of the most comprehensive and innovative community mental health and counseling centers in the country.

More than 600 clients are seen each week in individual, couple, family, or group therapy. Our psychiatrist provides medication services for clients in therapy at the Center. We offer support groups for divorce, seniors, women’s issues, bereavement, and other relevant topics. Check on what groups are available at this time. The Center recognizes the special needs of older adults with a senior peer counseling program for those over the age of 62.

The Center has outstanding programs for families and their children. In addition to providing therapy programs and parenting classes at our clinic, our counselors provide one-on-one and group sessions in Beverly Hills schools, as well as services at community-based organizations. Volunteers run highly effective Community Circle groups at local elementary schools, to help children enhance self-esteem, build character, and improve communication skills.

Our intern training program is highly sought after and attracts top candidates seeking experience toward licensure as psychologists, marriage and family therapists, clinical social workers, and professional clinical counselors. The Center has an excellent reputation for its intensive supervision and training curriculum.

The Center is open to you regardless of where you live. Fees for counseling are on a sliding scale, based on your ability to pay (we ask that you provide proof of financial need with appropriate documentation). It costs over $1 million to run our programs; every time a client is seen it costs the Center significantly more than our average fee per session for counselor supervision, training, and overhead expenses. Client fees help keep the Center open. The rest of the revenue comes from grants, fundraisers, and donations. You can and should discuss any concerns regarding your financial status with your counselor, especially if your financial situation changes or improves. Additionally, once per year your fee will be re-evaluated and if it is determined you are able to pay more, your fee may be adjusted.

We invite you to learn more about the Center. Feel free to ask about the many services available for you and your family. Welcome to the Center! We hope it will be a positive experience for you.


Susanna De Mari, LMFT
Clinical and Program Director

The Intake forms may be downloaded from the list below. Please choose the appropriate form.

**For a couple’s intake session, please fill out two individual intake forms.

** Parents and Guardians, please fill out the Additional Counseling Information form for your child or adolescent who is seeking counseling.

Individual Intake Packet

Family Intake Packet

Adolescent/Child Intake Packet

Adolescent/Child Information Form

Group Intake Packet

Couples Intake Packet

Notice of Privacy Practices 


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