66 Walnut St.

Assessments By Yount

66 Walnut St., Waynesville, NC 28786

Phone: 828-246-9886
FAX: 828-348-5538
 

 

Providing Professional Behavioral Health Care for 35 years!

 

Files, Forms, and the Necessary Paperwork To Get Started!

In order to more efficiently use "office time", you are encouraged to download and complete the following forms prior to your first office visit. This will assist me in taking care of the "nuts and bolts" of creating your account information in a timely manner. You may also fax the materials to me at 828-348-5538. I do NOT encourage you to email them to me unless you take steps to encrypt the file prior to sending it. Email is NOT secure and your confidential information could be intercepted.

File Name:
Purpose of this Form:
Required?
Policies/Procedures/Consents
This form should be read as it describes the Policies and Procedures of Assessments By Yount. It covers topics such as confidentiality, fee schedules, payment options, and requires your signature acknowledging you have been made aware of the information and granting your consent for services. (Note: this form is in pdf format. If you need a FREE pdf reader, click on the Adobe Reader link below.) Yes

General Demographic Information

This form provides the basics of how to contact you, mailing addresses, phone numbers, etc. Additionally, it provides background information useful in helping to establish with you a plan to reach your goals. (Note: this form is in pdf format. If you need a FREE pdf reader, click on the Adobe Reader link below.)

Yes

University of Rhode Island - Indicators of Change
The University of Rhode Island - Indicators of Change form is an assessment tool that I have found useful in helping to establish a plan to reach your goals that takes into account your current desires to change. Developing a plan with a consumer that isn't reflective of their current stage of change is an early step in the wrong direction. This information assists us in stepping out in the right direction from the beginning! (Note: this form is in pdf format. If you need a FREE pdf reader, click on the Adobe Reader link below.) Recommended
Fagerstrom Test of Nicotine Dependence
The Fagerstrom Test of Nicotine Dependence screening instrument can help you consider your relationship to nicotine and provide you with vital information regarding your health. (Note: Clicking on this link takes you to an external website for which Assessments By Yount has no control and is not responsible for the content therein.) Recommended

 

 

Home | Resources | About me | Get Started | Upcoming Events | Contact me | Hours of Operation | Site Map
Website materials copyright Cecil E. Yount, MA, LCAS, CCS 2010 - 2017 (All rights reserved)