Theresa M Cukierski
(419) 276-4416
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If you're a new client, please complete the following forms and bring them to your first therapy session.
Client Psychotherapy Intake Form
Limits of Confidentiality/Therapy Cancellation Policy
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
Authorization to Disclose Information Form
Note: To download Adobe Acrobat Reader for free,
Click here.
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Whether you’re ready to start therapy or simply exploring your options, reaching out is a simple first step
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Office hours & location
Monday
Closed
Tuesday
9:00 am - 5:00 pm
Wednesday
9:00 am - 5:00 pm
Thursday
9:00 am - 5:00 pm
Friday
Closed
Saturday & Sunday
Closed
Office Location
606 West Sophia Street
Maumee, OH 43537
(419) 276-4416
Theresa M Cukierski
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A space to slow down, reflect, and move forward.
In-person therapy in Northwest Ohio & online across Ohio.
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Home
About
Theresa M Cukierski
Therapeutic Services
Anxiety & Depression
Grief Counseling
Relationship & Communication Counseling
Stress Management
Trauma Therapy
Work and Career Issues
Practice Policy & Intake Forms
FAQ's
Online Forms
Blog
Privacy & Policy
Online Services
Counseling Fees & Insurance
Contact Me
OUR LOCATION
606 West Sophia Street
Maumee, OH 43537
(419) 276-4416
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