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Gulf Coast Rehabilitation Services, Inc.

Dr. Joshua Shannon LMHC, SAP, MCAP, CEAP, CDMS, CRC, CSAS

Helpful Forms

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Request Appointment

If you're a new client, please complete the following forms and bring them to your first therapy session.

Patient Intake Forms

  • Client Psychotherapy Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy
  • Insurance Form
  • Authorization to Disclose Information Form
  • PCL-5
  • PHQ-9
  • Medication History

DUI/Substance Abuse Intake Forms

  • Client Psychotherapy Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy
  • Authorization to Disclose Information Form
  • PCL-5
  • PHQ-9
  • Medication History

Workers Comp Intake Forms

  • Client Psychotherapy Intake Form
  • Insurance Form
  • Authorization to Disclose Information Form
  • PCL-5
  • PHQ-9
  • DWC-1 Required
  • Medication History

Assessments

  • PCL-5
  • PHQ-9

Resources

  • PTSD DBQ
  • CFR Evaluations
  • CFR Diagnosis
  • CFR Ratings
  • M21-1 Evaluation
  • M21-1 Service Connection


Forms in Spanish

  • Fomulario De Admision
  • Authorization to Disclose Information Form

Additional Forms:

  • Low Income/Sliding Scale Application
  • Medication History


Note: To download Adobe Acrobat Reader for free, click here.

Schedule Appointment

Start your new path in life and be the change today!

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Helpful Forms

Click here to view and print forms for your appointment.

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Tampa, FL Therapist

Dr. Joshua Shannon, LMHC
2909 W. Bay to Bay Blvd,
Suite 210
Tampa , FL 33629
877-957-3422 X 701

[email protected]


View Joshua Shannon, Ph.D. LMHC, CAP, SAP, CEAP, CRC's profile on LinkedIn


Serving Tampa, Clearwater, St Petersburg, Lakeland, Pinellas County, Polk County, Pasco County, Hernado County, Manatee County, and Sarasota County, FL

Services provided include DUI Evaluations, Substance Abuse Professional (SAP) Evaluations, Bereavement Counseling, Department of Transportation (DOT) Evaluations, Therapy for Trau ma, Social Media Groups, Video Game Addictions

HIPAA Secure Telehealth Available Nation Wide

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