Please download and fill out the 3 necessary forms and bring them with you to your first session.
- The Professional Disclosure must be signed by each client (for family, couples, and marriage counseling all signatures may be on one form). Download Professional Disclosure Form.
- Each client needs to fill out the appropriate Intake Form. The Intake Form for Minors is for all clients under the age of 18 and is to be filled out by parents with input from children when appropriate.
- The Notice of Privacy Practices must be signed by each adult client or by the parent of minors. This form refers to our Notice of Privacy Practices which is in a blue binder in our waiting room that you can read when you first get to the office so that you can turn in a signed form.
If you have problems downloading the forms, you may choose to arrive at your appointment 20 minutes early to fill out your initial paperwork in the waiting room. If you have any questions regarding the forms, do not hesitate to contact Brittany, or feel free to leave something blank and discuss it at your appointment.
Insurance Verification – Download Form
If you have insurance through Aetna, Blue Cross Blue Shield, or Humana and want to use your insurance for your counseling sessions, then please download the Insurance Verification Form. Fill out the top part of the form and email it to firstname.lastname@example.org. If you have access to a scanner, you can also include a copy of the front and back of your insurance card; otherwise, it is completely fine to just bring your card with you to your first appointment. If you are unable to email the actual form, then just email the applicable information. After receiving your form, Brittany will check on your insurance benefits and then contact you with the details.