Elaine will guide you to which forms clients will need to print and fill out. You will need Adobe Acrobat to download the following forms (all except forms 12 & 13 which are Excel documents). Most computers will have this program but if you do not please download here.
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1.
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Appointment and Referral Form |
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2.
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Information Sheet |
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3.
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Consent to Treatment |
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4.
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HIPAA Notice of Privacy Practices |
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5.
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Health Insurance Form (HCFA 1500) |
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6.
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Couple Therapy Agreement |
| 6a. Couple Therapy Questionnaire 1 | |
| 6b. Couple Therapy Questionnaire 2 | |
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7.
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Beck Depression Inventory |
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8.
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Depression Self-Rating Scale |
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9.
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Mood Disorder Questionnaire |
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10.
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Child Behavior Checklist |
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11.
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Caffeine Consumption Questionnaire |
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12.
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Male Prism Chart (Excel worksheet) |
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13.
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Female Prism Chart (Excel worksheet) |
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14.
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Authorization for Exchange – Release of Information |
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15.
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Suicide Prevention Contract |