Forms + documents

These are our fliers and forms (in PDF format); you will need Adobe Reader to read and print them.

Forms

You can complete these yourself and bring them with you when you first visit our offices.

  • Consent Form
  • HIPAA Release Form: This form describes the confidentiality of your medical records, how the information is used, your rights, and how you may obtain this information.
  • Client Intake Form: General information, symptom checklist, etc.
  • Financial/Billing Practices: Our policies about payments, insurance, cancellations, and related matters concerning client’s financial responsibilities.
  • Release of Information Form: Only needed if you want to allow MFT3 to speak with a physician, attorney, teacher, or anyone else concerning your case.

For your convenience, we’ve also assembled all of these forms into a complete package: download it here.

Fliers

  • Balance Wheel: An short exercise about aspects of partnership, intimacy, and connection in your life
Share

Comments are closed.