BuiltWithNOF
New Client Forms

 

Please fill out the forms in the right hand column prior to your first session.  Forms in the left column are for you to read, and then keep and review as needed. Forms in the right column need to be read, completed, signed and returned to the receptionist or your therapist before leaving Pathways at the end of your first session.  If you have an insurance card, have the receptionist or your therapist make a copy of your card so we can call and verify coverage.  After you have completed the forms, please wait in the waiting area until your therapist comes out. (He or she is probably with another client(s) at this time.) We look forward to working with you.

Read, Keep, and Review

Read, Complete, Sign, and Return

Office Policies, Informed Consent and Service Agreement

Client Acknowledgement of Receipt of Information

Notice of Privacy Practices Client Copy

Confidential Client Information

Clients Rights and Responsibilities

Precounseling Self Report

Description of Symptom

Description of Symptom Page 2

Medical History

Supervision Policy

Simple Agreement Form

Credit Card Authorization

Notice of Privacy Practices Office Copy

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