The forms new clients typically complete. Downloadable versions will be posted here as they are finalized.
Completing what you can before your first visit saves time. If anything is unclear, we will walk through it together.
| Form | What it is | Type |
|---|---|---|
| Client Registration and Intake | Basic contact, demographic, and referral information. | Intake |
| Notice of Privacy Practices (HIPAA) | How we protect and use your health information. | Privacy |
| Consent for Treatment | Your informed consent to begin counseling. | Consent |
| Confidentiality Notice (42 CFR Part 2) | Federal privacy protections specific to substance use records. | Privacy |
| Release of Information (ROI) | Authorizes us to coordinate with people or providers you choose. | Consent |
| Financial Agreement | Payment, insurance, and billing terms. | Billing |
| Telehealth Consent | Your consent to receive care by secure video. | Consent |
| Client Rights and Responsibilities | What you can expect from us, and what we ask of you. | Rights |
| Biopsychosocial and Chemical Use History | Background that informs your assessment and plan. | Intake |
| Medical History and Medications | Current health and medication information. | Intake |
| Emergency Contact and Safety Plan | Who to reach and steps to stay safe. | Safety |
| Program Agreement and Attendance | Expectations for participation and attendance. | Rights |
| Grievance Procedure | How to raise a concern and how we respond. | Rights |
| Payment Authorization | Optional card on file for balances. | Billing |
Downloadable PDF versions are being finalized and will be linked here.