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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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