Please print and complete the applicable forms and bring them to your initial counseling visit.

Confidentiality

Rights of Clients

HIPAA Privacy Policy

Consent to Treatment

Patient Information

General Symptom Checklist

Concerns Checklist

Insurance Agreement

Financial Agreement

  • Please select whichever Agreement applies according to whether or not you will be using insurance.

  • Cancellation Policy:  The policy states that any changes to scheduled appointments should be made at least 24 hours in advance. Unkept appointments which are not properly cancelled are subject to an unkept appointment fee, which can be equal to but not exceed the therapist's regular appointment fee. Insurance companies do not pay unkept appointment fees and the patient/responsible party is held fully accountable for the charge.