A Connecticut Nonprofit Organization dedicated to helping our first responders and veterans.

Please Read and submit the form below - Questions? email them here!

We have the wonderful blessing of having master’s level interns and pre-licensed clinicians working with us to provide the highest level of care and case management. All work done at HWC with an intern (that is, without a licensed clinician present) is done at no cost to you. Our interns may engage in the following activities. A licensed clinician will observe any intern-and pre-licensed clinician facilitated sessions quarterly. Please indicate your consent for the following intern activities by selecting "yes" (you do consent) or "no" (you do not consent):

1. Observe sessions with pre-licensed and licensed clinicians;.

Yes

2. Provide case management with clients;

Yes

3. Do check-in appointments with clients in between their regular appointments;

Option 1

Option 2

4. Facilitate group therapy

Yes

By entering your full legal name below you certify that you have fully read and understand the Intern Consent Form. You may obtain a written copy of this form by requesting it from Honor Wellness Center, Inc. in writing.

First Name

Last Name

Date

YYYY

Client Intern Acknowledgement

Please Read and submit the form below - Questions? email them here!

Honor Wellness Center is a nonprofit organization in Connecticut