Forms

Every client is required to sign and fill-out the following documents (which are included in the New Client Packet below), prior to the first session. These forms will be included in the confirmation email we send when scheduling the first appointment. You may preview the documents below. Note that some of these forms vary with each counselor.

  1. Statement of Understanding and Consent for Treatment
  2. Statement of Understanding and Consent for Electronic Communication
  3. HIPAA Notice of Privacy Practices
  4. Statement of Financial Responsibility
  5. Professional Disclosure Statement
  6. Confidential Client Intake Information

These optional forms are available if they apply to you. The Release of Protected Health Information form allows us to communicate and coordinate treatment with other health professionals or someone you designate. The ACH Payment form gives us permission to take payments directly from your bank and avoid additional transaction fees.

  1. Release of Protected Health Information
  2. ACH Recurring Payment Authorization

New Client Forms


Aaron Potratz' Forms

This is a PDF document that you will be required to sign and complete prior to the first session.

Click to download

These documents will be sent to you in the confirmation email for your initial appointment. You will need to fill them out and bring them with you to the first visit.

Download PDF document

Aaron Truong's Forms

Select this option if you need to download forms for Aaron Truong; these are required for all new clients.

Click to download

Please download and print, fill out, and sign the document then bring it with you to the first session.

Download PDF Forms

Renée's Forms

Select this option if you need to download forms for Renee Boles; these are required for all new clients.

Click to download

These documents will be sent to you in the confirmation email for your initial appointment. You will need to fill them out and bring them with you to the first visit.

Download PDF Forms

Sharon's Forms

This is a PDF document that you will be required to sign and complete prior to the first session.

Click to download

These documents will be sent to you in the confirmation email for your initial appointment. You will need to fill them out and bring them with you to the first visit.

Download PDF document

About Our Docs
Some of these documents are offered as Adobe Acrobat (PDF) files. Adobe® Acrobat® Reader™ is free, and freely distributable, software that lets you view and print Adobe Portable Document Format (PDF) files. This allows you to view and print the forms in their original format. You will need Adobe’s Acrobat Reader to view PDF documents downloaded from this site. Download Adobe’s FREE Acrobat Reader for PDF files.

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