Forms

-Hope Floats

After you have called to book an appointment for counseling services, please print out and complete the following packet as applicable. The packet includes all forms required at our practice. We are aware the information is quite thorough…as an integrative practice, we see the value in reviewing the complete picture to assist you in the most comprehensive manner.

Please arrive 15 minutes prior to your initial appointment with forms completed.

REQUIRED FORMS -Adult or Child/Teen:

 ADULT FORMS Adults age 18 and older

CHILD/TEEN FORMS Both parents’ consent required for children under the age of 18

PRIVACY POLICY For your review-does not need to be returned

 

AS NEEDED:

 AUTHORIZATION FOR RELEASE OF INFORMATION Allows us to consult with other individuals, professionals, or organizations involved eg. psychiatrist, psychologist, former therapist, school, etc.

 IMMIGRATION EVALUATION Hardship Waiver

 

Forms En Español

FORMAS NECESARIAS- Adultos o Niño / adolescente::

FORMAS PARA EL ADULTO Adultos mayores de 18 años

FORMAS PARA EL NINO O ADOLESCENTE Se requiere el consentimiento de ambos padres para menores de 18 años

AVISO DE LA POLIZA DE PRIVACIDAD Copia Del Cliente para su revisión

SEGÚN SEA NECESARIO:

AUTORIZACIÓN PARA LA DIVULGACIÓN DE INFORMACIÓN Nos permite consultar con otros individuos, profesionales u organizaciones involucradas por ejemplo. psiquiatra, psicólogo, terapeuta anterior, la escuela, etc.

INMIGRACIÓN EVALUACIÓN Dificultades Renuncia