FORMS

 


Forms for First Appointment
 

New patients:  Please complete the following forms and bring them to

your first appointment. Completing these forms prior to your appointment

will allow us more time for therapy.

Note: To download Adobe Acrobat Reader™ for free, click here.

Patient Confidential Information Form

HIPAA Authorization Form

Limits of Confidentiality Form

Professional Counseling Agreement

Consent for Counseling from A Christian Worldview

Psychotherapist – Patient Agreement

Patient Consent to Internet and Telephone Counseling

For all patients who would like us to coordinate care with another provider (for example, your psychiatrist, previous psychotherapist/counselor, primary care physician, etc.), complete this form to authorize release of protected health information:

Authorization for Use of Protected Health Information (ROI) Form