(309) 300-3072 | jamiesmithcounseling@gmail.com

Jamie Smith

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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

Client Registration

Authorization for Release of Information

Informed Consent for Individual Therapy

No Show/Late Cancellation Policy

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Jamie Smith



(309) 300-3072
jamiesmithcounseling@gmail.com

2103 East Washington Bldg 3
Bloomington, IL 61701

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Sat 9-2
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Contact Information

2103 East Washington Bldg 3
Bloomington, IL 61701

(309) 300-3072
jamiesmithcounseling@gmail.com

Jamie Smith Counseling, LLC does not and shall not discriminate in any of its activities or operations on the basis of race, creed, color, ethnicity, body size, national origin, immigration status, religion, sex, sexual orientation, socioeconomic class, gender identity, gender expression, age, physical or mental ability, veteran status, military obligations, relationship(s) and marital status.


This policy also applies to all of Jamie Smith Counseling, LLC's activities including its internal promotions, training, opportunities for advancement, terminations, outside vendors, members and customers, service clients, use of contractors and consultants, and dealings with the general public.

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