ALL NEW CLIENTS

Before our first counseling appointment, I will need you to prepare for our meeting by downloading forms # 1, 2 and 3 at your home or work. Print them out and review them. Fill out as much of the information asked for in the forms that you are comfortable with. If you are not sure about some things, leave them blank and we will go over it during our first session. Sign them and make copies for your records. You will need to scan the signed forms and email them to me at:   nitaprasadlmft@gmail.com

Click on the Adobe PDF Icon  next to the form name to download it to your computer.

Form #1   Counseling Client Intake Form →   

Form #2   HIPPA Notice of Privacy Practices  →

Form #3   Disclosure & Teletherapy Consent Agreement →

 

IF you have been in the past or are currently being seen by another medical professional (Doctor, Pediatrician, Psychiatrist, Therapist) for similar issues and you would like me to be able to discuss your case with them, THEN I will need your written authorization on Form #4, before I can disclose any confidential information.

Form #4   Authorization for Release of Confidential Medical Information → 

In general, healthcare providers are not permitted to use electronic communications that are not secure such as email, Skype, etc. However, if you want me to be able to send you appointment reminders by text or email, I will need to have a signed Form #5 on file with me authorizing me to use electronic communications.

Form #5   Electronic Communications Agreement  →