Inner Strength Counseling

Individual, Couple, Adolescent, and Family Counseling

Eleanor Salemi, LCSW

Florida Lic. SW9620

2840 West Bay Dr., Suite 253

Largo, FL 33770


Fax: 866.706.0538



By Appointment Only

Wed-Thu 10AM to 5PM

Sat By Appointment

Intake Packet – Couples

Personal History for Individual Adults (each person is required to complete and sign their own form)

No Secrets Policy For Couples and Families (signed by both)

Payment Contract for Services (Fee Agreement) (signed by person responsible for payment)

Privacy of Information Policies (only requires one signature)


Recipient's Rights Notification (read and keep)


Consent to Treat (each person signs one)


Services Provided


Credit Card Authorization

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