If you are a new client, please print and complete the following forms and bring them to our first session. Completing the forms in advance saves us time and allows us to focus on what is bringing you to counseling. I will review the information and policies in these forms at the beginning of our first session. If you have any questions or problems completing the forms in advance, please contact me.
- Disclosure Statement Form
- Financial Agreement Form
- Electronic Payment Authorization Form
- Client History Questionnaire
- HIPAA – Notice of Provider Practices + Acknowledgement
- Social Media Policy Form
- Insurance Information Form: Please complete this form and bring it along with your insurance card if you have Anthem BCBS or Rocky Mountain Health Plans and would like me to bill your insurance for services
For coordination of care with another provider (i.e. psychiatrist, primary care physician, dietitian, etc.) or to authorize me to communicate with another person regarding your care (i.e. parents), please complete the following form to authorize the release and exchange of information.