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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 contact the Admin Team at (636) 442-2612.

 

     New Client Consent Form

       The New Client Consent Form is a required step in the New Client Registration process. 

  

     Client Update Form

       The Client Update Form may be requested by the Admin team to update your information and consents.

 

     HIPAA Consent Update Form

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


Assessments

Your counselor may request that you complete one of the following assessments:

 

     Adult Self-Rated Symptom Measure

       The Adult Self-Rated Symptom Measure.

 

     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.

 

     Sponsorship Authorization

       The Sponsorship Authorization for Counseling Services.


Other Forms

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

 

     COVID-19 Waiver and Release

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

 

    Release of Information Authorization

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


 Informational Documents

 

     New Client Information and Consents Document

      The New Client Information and Consents Document contains detailed information regarding policies and procedures and consents and is a helpful reference for your information.