REGISTRATION

Your Enrollment Packet

Hello,
Thank You for choosing Counseling Services . Welcome to my counseling services. This page contains important information about my professional services and business practices. You can view and download the following forms (just click on each line and the pdf will open in a new window):

1. This instruction sheet
2. New client registration form
3. Counseling services contract & consent to treat form
4. New HIPAA & exceptions forms
5. Client clinical screening form
6. Client family history form
7. Emergency/support/resources list
8. Registration Parent symptom rating form for child
9. Adult Presenting Concerns
10. TeleHealth Registration and Guidelines

Please read carefully (paying close attention to the bolded areas) and complete all areas marked with an “x” . If you have any questions about the documents, please discuss them with your therapist before signing them. (NOTE: Please pay close attention to the Counseling Services Contract, in particular the section discussing child custody, FMLA, divorce , etc, related to counseling services.) Also if you are using private insurance such as Blue Cross, Aetna, Cigna, United Health Care or others, please contact them prior to your first session. There should be a 1800 number on your card to check on your behavioral health services, i.e. number of sessions, co-pays, deductible, etc.
NOTE: If you are using EAP sessions, this information is not needed.
Thanks and I look forward to meeting and working with you,