Important Forms & Contact Information
THANK YOU FOR SCHEDULING WITH I CHOOSE CHANGE! So we can spend more time talking, please fill out the correct forms below before your session:
IF YOU'RE AN ADULT SEEKING INDIVIDUAL, COUPLES, OR FAMILY COUNSELING, PLEASE USE THESE FORMS:
Adult - First
appointment paperwork - (Couples: Each person fill out, please)
HIPPA Compliance (Your
Rights as a Patient)
IF YOU'RE A PARENT / GUARDIAN SEEKING COUNSELING FOR YOUR CHILD, USE THESE FORMS:
Minor - First
appointment paperwork
HIPPA Compliance (Your
Rights as a Patient)
OTHER USEFUL FORMS:
Consent to Exchange Information
or Records
Consent to Treat Persons
Under Age 18
Informed Consent to Work with Counselor Intern
Insurance Reimbursment "Cheat
Sheet" (We will submit for you if you'd like, however!
Family of Origin worksheet (Optional form to help your therapist understand your family of origin)
Client Satisfaction Survey We value your opinion. Fill out anytime and fax, email, or mail - confidentially!
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