Forms
Forms by Therapist
Please click on your therapist’s name below, and complete each form.
Non-Medicare New Client Paperwork
- Fee Agreement for Mary Fitzgibbons, Ph.D.
- Client Information
- Initial Information Form
- Informed Consent for Therapy Services
- Informed Consent for Telephone or Online Counseling Services
- Notice of Privacy Practices
- Authorization to Release Health Care Information In Case of Emergency
Medicare New Client Paperwork
Provider Paperwork & Forms
- Fee Agreement for Amy V. Maus, M.S.W., L.C.S.W.
- Client Information
- Initial Information for Testing Services
- Informed Consent for Testing Services
- Notice of Privacy Practices
- Authorization to Release Health Care Information In Case of Emergency
- Informed Consent for Telehealth Testing Services
- Good Faith Estimate
Provider Paperwork & Forms
Non-Medicare New Client Paperwork
- Fee Agreement for Angela Cook, MSW, LCSW
- Client Information
- Initial Information Form
- Informed Consent for Therapy Services
- Informed Consent for Telephone or Online Counseling Services
- Notice of Privacy Practices
- Authorization to Release Health Care Information In Case of Emergency
Medicare New Client Paperwork
Provider Paperwork & Forms
Provider Paperwork & Forms
Medicare New Client Paperwork
- Medicare Billing Information
- Informed Consent for Therapy Services
- Notice of Privacy Practices
- Cancellation Policy for Medicare Clients
- Authorization to Release Health Care Information In Case of Emergency
Non-Medicare New Client Paperwork
Provider Paperwork & Forms
Provider Paperwork & Forms
Provider Paperwork & Forms
Provider Paperwork & Forms
Provider Paperwork & Forms
Non-Medicare New Client Paperwork
- Fee Agreement for Georgean Rustemeyer, MSW, LCSW
- Client Information
- Initial Information Form
- Informed Consent for Therapy Services
- Informed Consent for Telephone or Online Counseling Services
- Notice of Privacy Practices
- Authorization to Release Health Care Information In Case of Emergency
Medicare New Client Paperwork
Non-Medicare New Client Paperwork
- Fee Agreement for Theresa Wiss, LCSW, MSW, M.DIV
- Client Information
- Initial Information Form
- Informed Consent for Therapy Services
- Informed Consent for Telephone or Online Counseling Services
- Notice of Privacy Practices
- Authorization to Release Health Care Information In Case of Emergency
Medicare New Client Paperwork