Forms

Notice of Privacy Practices

The notice of privacy practices form contains information regarding how your health information may be used and disclosed and how you can get access to this information. Additionally, this form explains your rights with regard to your private health information (PHI). Please carefully read through this form, sign and date it prior to your first appointment and bring to the initial counseling session.

Informed Consent

The informed consent form provides information about counseling and what to expect during the counseling process. Additionally, this form describes possible limitations to client confidentiality. Please read, sign and date this form prior to your first appointment and bring to the initial counseling session.

Practice Policies

The practice policies form informs you about Wellbeing Counseling’s expectations regarding appointments, as well as information about what you can expect as a client receiving counseling services. Please read, sign and date this form prior to your first appointment and bring to the initial counseling session.

Release of Information

The release of information form allows us to communicate with providers who have treated or worked with you, or currently treat or work with you, in order to gather information pertinent to your treatment or to share information requested by you or your providers. This form is voluntary and will not be utilized if you do not sign it.

Adult Intake Form

The intake form helps prepare us to gather important information about you in order to best address your needs and goals in counseling. Please complete this form prior to your first appointment and bring to the initial counseling session.

Adolescent Intake Form

The intake form helps prepare us to gather important information about you in order to best address your needs and goals in counseling. Please complete this form prior to your first appointment and bring to the initial counseling session.

Child Intake Form

The intake form helps prepare us to gather important information about you in order to best address your needs and goals in counseling. Please complete this form prior to your first appointment and bring to the initial counseling session.