(907) 444-4867 | MariaBallard@upstreamcounseling.org

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Client Forms

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

Client Intake Form

Authorization for Release of Information

Upstream Consent Form

Credit Card Pre-Authorization Form

Limits of Confidentiality

Trauma Recovery Scale

Maria Ballard



(907) 444-4867
MariaBallard@upstreamcounseling.org

741 Sesame Street Suite 1B
Anchorage, AK 99503

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MariaBallard@upstreamcounseling.org

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