If you're a new client, your therapist will send you an invite to our online portal to complete your intake paperwork.
If you are unable to access the portal or prefer paper forms, please complete the following forms and bring them to your first therapy session or forward them to email@example.com or the therapist you will be seeing.
- Child & Adolescent Registration Form
- Adult Registration Form
- Consent for Treatment and Practice Policies
- Telehealth Consent
- Privacy Practices
If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.
- Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
- If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
- If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.
CORE Connection Counseling Privacy Practices
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