Keith Miller Forms

I look forward to meeting with you very soon. Please complete the forms and bring them to the first session or take the first few minutes of your session to fill them out after I greet you in the waiting area.

NOTE ABOUT PAYMENT: Payment is expected at each session. Checks or cash are preferred. Please make checks payable to “Keith Miller Counseling, LLC.”  We also accept Visa, MasterCard, and Discover (see credit card form below).

The following two forms are REQUIRED for meeting with Keith Miller:




The following forms are OPTIONAL and used only when needed


Consent for Release of Information