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    8981 Daniels Center Drive, Suite 209 | Fort Myers, FL 33912
    revivefamilycounseling@gmail.com
    (239) 329-9264

    Breathe. Smile. Revive.

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    • Home
    • About Us
      • Melissa Thompson, LCSW
      • Edita Hall, MS, LMFT- QS, MHC- QS, MT 2727  
      • Kerriann Now, LMHC, CAP, EMDR, MH19154
      • Vanessa Garza, RMFTI
      • Peter Haladej, M.Div., M.A., RMHCI
    • Services Provided
      • Family Therapy
      • Marriage & Couples Counseling
      • Therapy For Children and Teens
      • Individual Therapy in Office and Online
      • Tele-Mental Health
      • FL Board Qualified Supervision for MHC and MFT registered interns
      • Trauma Therapy
      • Affair Therapy
      • Divorce Therapy
    • Getting Started
      • FAQs
      • Rates and Insurance
      • Appointment Request
      • Pay My Bill
      • The No Surprise Act and Good Faith Estimate
      • Notice of Privacy Practices
    • Helpful Resources & Articles
      • Mental Health Links
      • Physical Health Links
    • Contact
    • Blog

    Client Forms

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

    Client Intake Form

    Information Sheet

    Limits of Confidentiality

    If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

    Authorization for Release of Information

    Contact Today



    8981 Daniels Center Drive, Suite 209 Fort Myers, FL 33912

    (239) 329-9264
    revivefamilycounseling@gmail.com

    Request An Appointment

    Contact Today

    Revive Family Counseling, LLC
    revivefamilycounseling@gmail.com | (239) 329-9264

    A Website by Brighter Vision | Privacy Policy

    • Home
    • About Us
      ▼
      • Melissa Thompson, LCSW
      • Edita Hall, MS, LMFT- QS, MHC- QS, MT 2727  
      • Kerriann Now, LMHC, CAP, EMDR, MH19154
      • Vanessa Garza, RMFTI
      • Peter Haladej, M.Div., M.A., RMHCI
    • Services Provided
      ▼
      • Family Therapy
      • Marriage & Couples Counseling
      • Therapy For Children and Teens
      • Individual Therapy in Office and Online
      • Tele-Mental Health
      • FL Board Qualified Supervision for MHC and MFT registered interns
      • Trauma Therapy
      • Affair Therapy
      • Divorce Therapy
    • Getting Started
      ▼
      • FAQs
      • Rates and Insurance
      • Appointment Request
      • Pay My Bill
      • The No Surprise Act and Good Faith Estimate
      • Notice of Privacy Practices
    • Helpful Resources & Articles
      ▼
      • Mental Health Links
      • Physical Health Links
    • Contact
    • Blog