There are7 formsin total that you will need to bring with you. My sincere apologies for the volume of paperwork. Best practice as well as current state and federal laws/regulations/codes require much of this documentation be provided. Choose either the adult or child checklist based on the age of the client. Please allow yourself at least 30 minutes to fill out the paperwork.REMEMBER:THE START OF YOUR SESSION WILL BE DELAYED AND SHORTER IF I HAVE NOT RECEIVED ALL THE FORMS COMPLETED.You may drop the forms off ahead of time or bring them to the first session. If you have any questions, we will address them at the time of your appointment.
If you are having trouble printing the forms, please contact me at least 24 hours in advance and I will email or fax you the paperwork or you can come in 30 minutes early to fill it out. All forms are in PDF format. If you need a different format, please contact my office.
If the client is under the age of 18, I request signatures from both parents authorizing treatment and both parents present at the initial session [child NOT present]. If the child is not living with both biological parents, I will need a copy of the MOST RECENT court custody documents and request an individual session with each parent prior to beginning work with the child if at all possible. You are responsible for providing any updates to the court paperwork to me at the next session after receiving the new court documents. Failure to do so may mean that your child will be referred out of this practice. Children under the age of 18 can consent for their own treatment under specific circumstances. Please contact the office for more information.
NOTE: Release of Informationis needed for me to be able to communicate with members of your treatment team [doctor, dietitian or psychiatrist etc.] It is also used to communicate with former therapists, family members, treatment facilities, schools and in the case of marital or pre-marital work, each member of the couple MUST complete a release listing their partner as someone with whom I can share information. If there is no one you wish to share information with, you do not need to complete this form prior to session.
A release is also required if someone else is paying for treatment so that billing questions or problems may be discussed with the payor.
If the patient is a child, both parents and the child may fill out their own child checklists about the issues concerning the child.