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
mary.peacock@mingesbrookcs.com

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 *
Policies, Services, & Fees *
 
* Indicates this form is required to be filled out by all new Clients and brought to the first visit.