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:
Online forms are now submitted via your Client Portal, which you receive access to upon scheduling your appointment (click here).
To get your Client Portal link sent to you, contact our office at info@ichoosechange.com or talk to your counselor.
Additionally, if you’re a current or previous client, we’d love if you’d tell us how were doing by filling out this anonymous survey: here.
Or, PRINT and fill out your form:
Additionally, please read and be informed of this information:
HIPAA Compliance and Confidentiality (Your Rights as a Patient)
Professional Disclosure Statement and Consent to Treat
Internet Counseling and Communication
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.
Evaluation Survey – Your feedback matters! – We value your opinion. Fill out anytime and fax, email, or mail – confidentially!