ChristianCounselingConnection welcome

ccc from lake office view

 

Client Forms

The Admin Team may request that you complete one or more of these forms. If you have questions, please contact the Admin Team at (636) 442-2612.


     Adult New Client Forms

       The Adult New Client Forms e-signature packet is a required part of the registration process.

 

     Minor New Client Forms

       The Minor New Client Forms e-signature packet is a required part of the registration process for clients under 18 years of age.


These forms are all included in the New Client Forms, but may be requested separately by our Admin staff if updates are needed:

     Waiver & Release - COVID-19

       Clients must complete the Waiver & Release - COVID-19 form before returning to the office for in-person sessions.

     Electronic Payment Authorization

       The Electronic Payment Authorization form authorizes credit card payments.

     Informed Consent for Telehealth Services

       The Informed Consent for Telehealth Services form provides information and authorizes telehealth services.

     HIPAA Consent

       The HIPAA Consent form authorizes the release of information regarding scheduling and billing. 

     Release of Information Authorization

       The Release of Information Authorization form must be completed before protected health information may be released. 


Complete this form to register for our TalkTime20/20 telehealth "check-in" sessions:

     TalkTime20/20 Information and Consent

       The TalkTime20/20 Information and Consent form must be completed prior to the first FREE TalkTime20/20 telehealth check-in consultation support session.