Forms

Counseling information and required forms

  • File

    RECEIPT OF PRIVACY PRACTICES.docx

     (14K)
    This acknowledges that you received the HIPAA information. Please sign and bring with you to your first session.
  • File

    INTERNET CONTACT POLICYt.docx

     (14K)
    This talks about limits of internet contact between you and the counselor. Please print, sign and bring to your first session with you.
  • File

    NO SECRETS for FAMILY/COUPLE THERAPY

     (11K)
    Important information regarding how information communicated to a therapist is utilized in family or couples sessions. Please have all members who will be participating in counseling sign this document and bring with you to your first session.
  • File

    NOTICE OF PRIVACY PRAXCTICES-HIPAA.docx

     (19K)
    Imporant information about how health insurance is stored, shared and communicated. Please read. You do not need to bring this to your first session.
  • File

    OFFICE POLICIES/AGREEMENT OF SERVICES.doc

     (42K)
    Here you will find important information regarding office policies; scheduling, cancellations, emergencies, confidentiality, fees, the process of counseling and termination. It is important that you read this document entirely and ask questions if you have them. Please sign and bring the the first session.
  • File

    PERSONAL INFORMATION/HISTORY.docx

     (19K)
    This is a questionnaire to help me to get to know you and your situation better. Please fill out and bring to your first session.