Notebook and Fountain Pen

Forms

About

The following are forms that will be needed before you begin therapy.  For the required forms, these will need to be filled and returned prior to (or at the time of) your first appointment.

The optional forms are for the pupose of care coordination with your other healthcare providers.

 

*You can view and download all forms and documents by clicking the red "PDF" icons throughout this page.    

For your convenience, we have listed instructions for ways in which you can complete and return forms.

Required Forms
  • Telehealth Consent for Services​​
  • Client Information Form
  • HIPAA Authorization Form
  • Informed Consent for Services and Policies
  • Notice of  Privacy Practices
  • Receipt of Notice of Privacy Practices
  • Professional Disclosure Statement - Victoria Butler
  • Professional Disclosure Statement - Monica McLamb
Optional Forms
  • Authorization for Release of Information
  • Referral Form for Providers