Forms
Beginnings are scary. Endings are usually sad, but it’s what’s in the middle that counts. So, when you find yourself at the beginning, just give hope a chance to float up and it will.
-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 5 minutes prior to your initial appointment with forms completed.
Forms in English
REQUIRED FORMS -Adult or Child/Teen:
(Adults age 18 and older) (Both parents’ consent required for children under the age of 18)
(For in-office sessions) (For virtual and phone sessions)
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
Formas en Español
FORMAS NECESARIAS- Adultos o Niño / adolescente::
FORMAS PARA EL ADULTO Adultos mayores de 18 añosFORMAS 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 revisiónSEGÚN 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