Minges Brook Counseling Service
 9 Heritage Oak Lane, Suite 9
Battle Creek, Michigan 49015
24 Hr. Phone 269-979-4800
 Directions to Minges Brook Counseling Service
Mary Peacock, LMSW, ACSW
 Licensed Master Social Worker
 marypeacock@ctsmail.net

Personal Information Sheet
Notice of Privacy Practices
Privacy Practices Receipt
Personal Checklist
Resume
Fee Schedule

 Owen Bolton, LMSW, ACSW
 Licensed Clinical Social Worker
 owenlbolton@gmail.com

Introduction to Clinician
Client Information Form
Statement of Understanding for Couples Therapy
DASS 21 Questions
Client Insurance Form
Release of Authorization for Health Insurance
Notice of Privacy Practice
Privacy Practices Receipt
Charges and Fees