breaking free services center for wellness logo | Counseling and Therapy in Tarpon Springs Florida

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1501 South Pinellas Ave, Suite P, Tarpon Springs FL 34689
727-547-3692   |   clientcare@breakingfreeservices.com

Breaking Free Services

  • Home
  • Meet Our Team
    • Shari Linger, MS, LMHC, CEO
    • Kathi Hannon, MA, LMHC
    • Megan Roberts, MA, LMHC
    • Dorjan Kraja, MA, LMHC
    • Lisa Martino, LMT, CPMT
    • Maureen Murphy-Lee, MS, LMHC
    • Piper Stannard Vanderlee, MSW, LCSW
    • Gabby Lafond, MSW, Registered Clinical Social Work Intern
    • Jessica Dorey, MSW, Registered Clinical Social Work Intern
    • Kaitlyn Shelp, MA, Registered Mental Health Counselor Intern
    • Marvin Polanco, MA, Registered Mental Health Counselor Intern
    • Melissa Smetzer, MSW, Registered Clinical Social Work Intern
    • Savannah Arseneau, MS, Registered Mental Health Counselor Intern (pending)
    • Stephanie Barnes, M.ED, Registered Mental Health Counselor Intern
    • Troy Bishop, MS, Registered Mental Health Counselor Intern, CCTP
    • Alyssa Davis, BA, Graduate Practicum Intern
    • Cheryl Stephenson, BSW, Graduate Practicum intern
    • Dallas Henderson, BA, Graduate Practicum Intern
    • Elizabeth DiMartino, RN, Mental Health Nurse Practitioner Intern
    • Meagan Cherry, MA, Registered Mental Health Counselor Intern
  • Services
    • Counseling
    • Massage
    • Supplements
    • Yoga
  • Getting Started
    • Client Forms
    • Rates & Insurance
    • Appointment Request
    • FAQs
  • Resources
    • Mental Health Links
    • Physical Health Links
  • Blog
  • Contact
  • Join Our Team
  • Referrals
  • Share Your Feedback

Client Forms

All New Clients
General Client Intake Packet

New Clients Aged 12-18
Teen Questionnaire

Optional for All Clients
Consent to Release Verbal & Written Information

 

Not sure which forms to fill out?

Adults: Please fill out the General Client Intake Packet and Consent to Release Information (optional, if there is anyone with whom you wish us to communicate).

Teens: Parents, please fill out the General Client Intake Packet and Consent to Release Information ((optional, if there is anyone with whom you wish us to communicate). Have your teen complete the Teen Questionnaire

Children Under Age 12: Parents, Please fill out all forms except the Teen Questionnaire

breaking free services logo | Therapy and counseling in Tarpon Springs Florida
Counseling, Massage Therapy, Health Coaching, Nutrition Planning, Yoga & Acupuncture

Phone: 727-547-3692

Email: clientcare@breakingfreeservices.com

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"It's okay to not be okay,
It's just not okay to stay there."
-- Matt Chandler, The Village Church

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A Website by Brighter Vision

  • Home
  • Meet Our Team
    ▼
    • Shari Linger, MS, LMHC, CEO
    • Kathi Hannon, MA, LMHC
    • Megan Roberts, MA, LMHC
    • Dorjan Kraja, MA, LMHC
    • Lisa Martino, LMT, CPMT
    • Maureen Murphy-Lee, MS, LMHC
    • Piper Stannard Vanderlee, MSW, LCSW
    • Gabby Lafond, MSW, Registered Clinical Social Work Intern
    • Jessica Dorey, MSW, Registered Clinical Social Work Intern
    • Kaitlyn Shelp, MA, Registered Mental Health Counselor Intern
    • Marvin Polanco, MA, Registered Mental Health Counselor Intern
    • Melissa Smetzer, MSW, Registered Clinical Social Work Intern
    • Savannah Arseneau, MS, Registered Mental Health Counselor Intern (pending)
    • Stephanie Barnes, M.ED, Registered Mental Health Counselor Intern
    • Troy Bishop, MS, Registered Mental Health Counselor Intern, CCTP
    • Alyssa Davis, BA, Graduate Practicum Intern
    • Cheryl Stephenson, BSW, Graduate Practicum intern
    • Dallas Henderson, BA, Graduate Practicum Intern
    • Elizabeth DiMartino, RN, Mental Health Nurse Practitioner Intern
    • Meagan Cherry, MA, Registered Mental Health Counselor Intern
  • Services
    ▼
    • Counseling
    • Massage
    • Supplements
    • Yoga
  • Getting Started
    ▼
    • Client Forms
    • Rates & Insurance
    • Appointment Request
    • FAQs
  • Resources
    ▼
    • Mental Health Links
    • Physical Health Links
  • Blog
  • Contact
  • Join Our Team
  • Referrals
  • Share Your Feedback