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.

 

Electronic Payment Authorization

The Electronic Payment Authorization form authorizes credit card payments.

 

Waiver & Release - COVID-19

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

 

Informed Consent for Telehealth Services

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

 

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.

 

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.