Click on link below to download:



Helpful Forms

-For your first appointment please print and complete applicable forms and bring to your initial appointment.


-The "HIPPA Notice" is to inform you of

  HIPPA regulations regarding your protection 

  of privacy. Please keep this form.


-Please bring  Drivers License & Insurance card





2524 Valleydale Rd. Suite 101  Birmingham, Al 35243

P 205.585.8761

F 205.982.8465

source4change@icloud.com

Source For Change Counseling

Dana S Smallwood LCSW, PIP 


With a loving dedication to my own growth, I began studying principles to help others find a Source for Change in their own lives...