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GrowthBRINGS POSITIVE CHANGE

Client Forms

Many new clients prefer to download and print the intake paperwork prior to their first session in order to allow more time to review the information, and ensure that the appointment time is used efficiently. If you choose not to print and complete these beforehand, or are unable to do so for any reason, please let me know, and I will leave the forms for you in the waiting room to complete prior to the session. Please note that you should plan to arrive approximately 30 minutes early in order to complete paperwork if you do not do so prior to the session, especially for couple and family therapy where more forms are often needing to be completed.

The intake paperwork varies depending on the modality of therapy in which you are engaging. If you have any questions, please feel free to call me at (210) 496-0100 or email [email protected] Please read the information below carefully to determine which documents are needed, and then follow the links to .pdf files at the bottom of the page. 

Individual Adult Psychotherapy- Please review the Notice of Privacy Practices (no need to print or bring with you- this form is for informational purposes only), complete the Adult Information Form, Informed Consent, and Pre-Authorized Billing Agreement. You may also complete the Release of Information form if there is anyone with whom you would like for me to share information, such as a family member, physician, or attorney.

Couple Therapy- Please review the Notice of Privacy Practices (no need to print or bring this with you- this form is for informational purposes only). Each partner/spouse should complete an Adult Information Form separately. Both should also read the Informed Consent document and initial/sign where indicated on page 4. Both or one of the spouses/partners should provide contact information and complete the Communication Consent section of the document to indicate with whom and how I should communicate regarding appointments and other information. At least one copy of the Pre-Authorized Billing Agreement should also be completed. Couples who wish to split the costs of therapy may provide multiple copies of this form, and provide directions for billing during the first session. Finally, one or both members of the couple may also complete a Release of Information form if there is anyone with whom I may need to share information, such as a family member, physician, or attorney.

Child or Family Therapy- Parents/guardians please review the Notice of Privacy Practices (no need to print or bring this with you- this form is for your informational purposes only). Please complete a Child/Adolescent Information Form for each child to be participating in therapy, and a Minor Consent Form (can name multiple children on single form). If legal custody or guardianship of the child(ren) has been modified, defined, or in any way impacted by a Court Order or Decree, a copy of the most current legal document also needs to be provided at the first session. 
When I am working with minor children, I also define the parents/guardians participating in the therapeutic process as clients as well. This definition is not only for clinical purposes, but also for legal and ethical clarity in managing records and protecting confidentiality. Therefore, I require that adults participating with the child complete forms for themselves in addition to the child(ren) as a part of the intake paperwork. Each adult (e.g., parent, step-parent, grandparent, guardian, sibling age 18 or older) participating in therapy should also complete an Adult Information Form for themselves, and sign an Informed Consent form. Multiple copies of the Informed Consent may be needed if the communication preferences are different for the adult participants.
At least one copy of the Pre-Authorized Billing Agreement should also be completed. In the event that costs for therapy are to be divided between multiple parties or accounts, please complete one form per account to be charged and provide directions for billing during the first session. Finally, a Release of Information form may also be needed if there is anyone with whom I many need to share information, such as school personnel, other family members, or a physician.
 
Form Links:

Adult Information Form
Adult Informed Consent 
Child/Adolescent Information Form
Minor Consent Form
Pre-Authorized Billing Agreement
Release of Information 
Notice of Privacy Practices

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