Monarch Therapeutic Services, LLC Transforms Distress Into Hope
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  • Home
  • Appointments
  • Contact
  • FAQs
  • Forms
  • Insurance, Rates & Payments
  • Referrals
    • Referrals
    • Referral Form
  • Groups, Workshops & Seminars
    • Addiction Recovery Programs
    • Art Of Marriage
    • Coping With Challenges of Childrearing
    • Emotional Eating Support Group
    • I Love You & I Am Listening
    • Inner Canvas Programs >
      • Inner Canvas Manga & Anime
    • Restoring Broken Bonds of Trust
    • S.E.E.D.S.
    • Sister Circle >
      • Sister Circle Group Resources
    • Stress Less with Prayer & Meditation
    • Supporting the Whole Self
  • Services
    • Services
    • Addiction Counseling
    • Case Management
    • Coaching >
      • Coaching Packages
    • Mood & Anxiety Counseling
    • Trauma Recovery Counseling
  • Treatment Interventions
  • Category
  • New Client Intake Assessment
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YOUR CART

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 Monarch Therapeutic Services, LLC



FORMS
CLIENT INTAKE PACKETS
New Client Clinical Intake  
Adolescent Assessment Pkt (11-17yo)
Adult Assessment Pkt (18+ yo)
CLIENT FORMS
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Consent for Services    
Demographic Information 
Financial Agreement - insurance 
Financial Agreement - out-of-pocket  
CLIENT FORMS
Privacy Notice  
Release of Information  
Request for Records  
​Sliding Fee Discount Application 
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. 
Assessment Forms - by Condition
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) 
Assessment Forms - by Condition
PSYCHOSOCIAL FUNCTIONING
OHIO - Parent Form 
OHIO - Youth Form 
Pediatric Symptom Checklist - Parent Form 
Pediatric Symptom Checklist - Youth Form 

SUBSTANCE & ALCOHOL DEPENDENCE/ADDICTION

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 

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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
410 State Street, 2nd Floor left, Office #8
Wednesday   10am - 7pm
Thursday      10am - 8pm

WALLINGFORD - Currently Closed to in-person sessions

TELEHEALTH
Monday        12pm - 6pm
Tuesday         9am - 8pm
3 options to schedule appointments:
​> Click button below
> Call schedule line at:  203.405.0837
> Text  schedule line at: 203.405.0837 
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