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Client Forms

Forms For New Clients

Please contact Dr. Diak to discuss your situation before completing any forms. New clients must complete each of the 3 forms before scheduling their first session. After you complete the forms please send them to Dr. Diak. Having the forms completed ahead of your first session will save session time. Upon receiving your completed forms Dr. Diak will review them and contact you. You will then be able make an appointment for a counseling session.

The forms to complete are:


  1. Click on each form to view
  2. Print each form
  3. Fill in each form
  4. Send the completed forms to Dr. Diak

How To Send The Client Forms

There are several convenient ways to send your completed forms. Chose the method you are most comfortable with:

  • Mail 

Mail paper copies to:
    Dr. W. F. Diak III
    The Happiness Psychologist
    28870 US 19N, Suite 357
    Clearwater, FL 33759

  • Fax

Fax them to my confidential fax machine at:

(727) - 772-5726

If you do not have a fax machine of your own you can send faxes from many office supply stores such as Staples. Use the self-service fax machine to protect your confidential information.

  • Skype

Scan them, and send as file attachments using Skype to:
Chat with me

  • Email

Email them by scanning and sending as attachments using secure protected, encrypted email:* 

If you need help downloading, printing, or sending the forms contact Dr. Diak at (727) 280-6569. 

If you cannot view the forms you may need to download the free Adobe Reader program. Click on Adobe Reader to download it. After installing Adobe Reader try to download the forms again.

Adobe Reader

*If you do not know how to send secure protected, encrypted email do not chose this option.