MONARCH THERAPEUTIC SERVICES, LLC TRANSFORMS DISTRESS INTO HOPE
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  • Welcome
  • Services
    • Services
    • Request for Services
    • Therapeutic Coaching
    • Anxiety and Mood Disorders
    • Addiction Recovery
    • Trauma Recovery
    • Relationship Coaching
  • Appointments
  • Resources
  • Payments
  • Contact
    • Contact
  • Client Portal
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 Monarch Therapeutic Services, LLC



FORMS
Counseling & Coaching Intake Forms
New Client Clinical Intake  
Adolescent Assessment Pkt (11-17yo)
Adult Assessment Pkt (18+ yo)​
Couples/Relationship Counseling Intake  
Consent Forms
Consent for Services    
Demographic Information
Privacy Notice  
Release of Information  
Request for Records 

Client Satisfaction Survey 
VEYO Transportation Request 

Financial Forms
 Financial Agreement - insurance 
Financial Agreement - out-of-pocket  
​Sliding Fee Discount Application 
Sliding Fee Discount Criteria - 2022 

ASSESSMENT FORMS
(by condition)
Therapeutic Assessments are used to diagnose disorders, plan treatments, evaluate the effectiveness of interventions, and facilitate positive changes in clients. The forms below are in pdf format. 
ADHD & other attention problems
NICHQ Vanderbilt Assessment Scales - Parent Form
NICHQ Vanderbilt Assessment Scales - Teacher Form
Anxiety
Beck's Anxiety Inventory (BAI)
GAD-7

​Screen for Child Anxiety Related Disorders (SCARED)
Behavior & conduct problems
Child and Adolescent Disruptive Behaviors - Parent Form
Child and Adolescent Disruptive Behaviors - Teacher Form
Columbia Impairment Scale - Parent Form
Columbia Impairment Scale - Youth Form
Depression & other mood disorders
Beck's Depression Inventory (BDI)
​Birleson Self-Rating Scale for Child Depressive Disorder 

CES Depression Scale for Children 
CIDI Bipolar Spectrum Disorder Screening Tool 
Moods Disorder Questionnaire (MDQ) 
Patient Health Questionnaire (PHQ-9) 
Psychosocial Functioning
OHIO - Parent Form 
OHIO - Youth Form 
Pediatric Symptom Checklist - Parent Form 
Pediatric Symptom Checklist - Youth Form 
Substance dependence & other addictions
Addiction Severity Index 
Drug Abuse Screening Test (DAST) 
Substance Use Assessment
 
Suicide risk
Columbia Suicide Severity Rating Scale (CSSRS) 
Trauma
Life Events Checklist (LEC) 
PTSD Checklist (PCL-5) 
Traumatic Events Screening Inventory - Children Form (TESI-C)
Traumatic Events Screening Inventory - Parent Form 

Admin a.m.  Admin p.m. ​  Workorder 

CONTACT

LOCATIONS & HOURS

SCHEDULING

OFFICE PHONE:  203.587.8650
OFFICE FAX:       866.881.6464

EMAIL: monarchpsychotherapy@gmail.com 

MAILING ADDRESS:
PO Box 8101, Manchester CT 06040

NORTH HAVEN, CONNECTICUT
410 State Street, 2nd Floor left, Office #8

ADMINISTRATIVE HOURS
The office manager is available to receive and respond to calls, messages, texts, emails, and faxes
Monday - Thursday 10am - 6pm ET


CLINICAL HOURS (by appointment only)
IN-OFFICE | TELEHEALTH
Wednesday   8:00am - 7pm ET

Thursday      8:00am - 7pm ET
Schedule appointments:
​> Click button below
> Call/Text:  203.405.0837
REQUEST APPOINTMENT
Copyright © 2016
  • Home
  • Welcome
  • Services
    • Services
    • Request for Services
    • Therapeutic Coaching
    • Anxiety and Mood Disorders
    • Addiction Recovery
    • Trauma Recovery
    • Relationship Coaching
  • Appointments
  • Resources
  • Payments
  • Contact
    • Contact
  • Client Portal