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(954) 610-1125 | Enid@counselingsolutionsofbroward.com

Counseling Solutions of Broward LLC

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Client Forms

If you are new, please be sure to fill out the following forms, and bring them to your first session. This will help ease you in and allow as much time as possible to focus on you.

Client Intake Form

Information Sheet

Limits of Confidentiality

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information

Contact Today

11322 Miramar Parkway
Miramar, FL 33025
(954) 610-1125
Enid@counselingsolutionsofbroward.com
 

 

Office Hours

By Appointment Only

Tuesday 1pm-7pm
Wednesday 1pm-7pm
Thursday 1pm-7pm
Friday 1pm-4pm

 

 

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By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

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Contact

Enid De Jesus LMHC

(954) 610-1125

Enid@counselingsolutionsofbroward.com

Office Hours

By Appointment Only

Tuesday 1pm-7pm
Wednesday 1pm-7pm
Thursday 1pm-7pm
Friday 1pm-4pm

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Office Location

11322 Miramar Parkway, Miramar, FL, 33025