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Client Forms
The Admin Team may request that you complete one or more of these forms. If you have questions, please text or call the Admin Team at (636) 442-2612.
Assessments
Your counselor may request that you complete one of the following assessments:
Adult Self-Rated Symptom Measure
The Adult Self-Rated Symptom Measure.
Minors Self-Rated Symptom Measure
The Self-Rated Symptom Measure for Minors Age 11–17.
Parent/Guardian-Rated Symptom Measure for Minors Age 6-17
The Parent/Guardian-Rated Symptom Measure for Minors Age 6-17.
Sponsorship of Counseling Services Authorization
If you or your organization would like to sponsor counseling services for others, please complete this form to authorize payments for sessions.
The Sponsorship Authorization for Counseling Services.
Informational Documents
HIPAA Policy - Notice of Privacy Practices Document
The HIPAA Policy - Notice of Privacy Practices Document explains how medical information about you may be used and disclosed and how you can get access to this information.
No Surprises Act "Good Faith Estimate" Notice
The No Surprises Act "Good Faith Estimate" Notice explains your right to receive an estimate of the bill for medical items and services.