Client Therapy Forms

If you are being seen in the Reno, Nevada office, you can click here and print out the .pdf (Adobe Acrobat) file containing all of these documents and forms.... Click Here

If you are seeing one of us in Minnesota , you can click here and print out the .pdf (Adobe Acrobat) file containing all of these documents and forms... Click Here

In addition, Click Here for the Therapist Release Form That Is Used Specifically For The ClearLife Clinic.

Explanation of Client Therapy Forms

Clients who see us for individual, couple, family, or group psychotherapy must fill out and bring to the first session the following forms, which can be accessed by clicking on the links ABOVE.

1. Intake Form (4 pages)-- Must be filled out completely and signed

2. HIPAA Privacy & Patient Agreement Signature Forms (two signature pages acknowledging that you received our HIPAA Privacy Notice, our Patient Services Agreement, and that you understand that we are not Medicare Providers, and that you therefore may NOT bill Medicare for the services that we provide to you. The Privacy Notice and Patient Services Agreement will print out along with these other forms.

3. Release of Information Form for your most recent therapy, or for your physician, psychiatrist, clinic, treatment program, etc. if applicable.

4.  2007 Men's Group Rules/Contract Signature Form required before participation in one of John's men's groups.

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