New Clients

Please download, print and complete forms 1 through 5 prior to your first appointment. Forms 6 and 7 are optional. Bring the completed forms to your appointment, along with your medical insurance card if you are using your insurance.  Co-pays and fees are due at time of service.

1.  Office Policies & Consent (rev 12/30/15)
2.  Insurance Information & Consent (rev 12/30/15, required if paying with insurance)
3.  Client Contact Information (rev 12/30/15)
4.  Client Personal History (rev 12/30/15)
5.  Summary of Privacy Practices (HIPAA Signature Page, rev 12/30/15)

6.  Consent to Communicate by Email (rev 12/30/15, optional form)
7.  Authorization for Release of Mental Health Information (rev 12/30/15, optional)

The Notice of Privacy Practices document, available below, is for your information and reference and does not need to be signed or returned to Full Circle Counseling & Consulting. You may download a copy for your files if you wish.

Note: The above forms are in PDF (.pdf) format.  To view these forms, you will need a PDF viewer installed on your computer/device.  You can download Adobe Acrobat Reader for free HERE.