Important Paperwork

So we can spend more time talking, please fill our your new client paperwork prior to your session. Guardians of minors under age 17 should fill this out for the child. Please also read the below documents before filling out paperwork.  Thank you!

Submit necessary forms ONLINE by clicking below:

ADULT New Client Paperwork (including couples)

CHILD New Client Paperwork

Informed Consent to Work with Counselor Intern

Consent to Exchange Information or Records

Consent to Treat Minors (age 17 and under)

Or, PRINT and fill out your form:

ADULT New Client Paperwork (including couples)

CHILD New Client Paperwork

Informed Consent to Work with Counselor Intern

Consent to Exchange Information or Records

Consent to Treat a Minor

 

Additionally, please read and be informed of this information:

HIPPA Compliance (Your Rights as a Patient)

Professional Disclosure Statement and Consent to Treat

Other useful forms:

Insurance Reimbursement CHEAT SHEET - Use this form as a guide to obtain insurance reimbursement from your appointments.

Payment Information - Use this form to update your payment information.

GROUP Intake Packet - When participating in a group at I Choose Change, use this form.

How To Guide: Google Chat & Video – Setup instructions for Google Video or Chat sessions.

Evaluation Survey – Your feedback matters! – We value your opinion. Fill out anytime and fax, email, or mail – confidentially!

You’ll need Adobe Reader to download the above documents. Click this button to download now:

 

Adobe Reader

Love the couch. Love yourself.©

Call I Choose Change / Allen Counseling Center to schedule your free consultation now:  214-547-1318