Please fill out all forms in the 18-page packet below. The first two pages, called “Disclosure Statement” are State of Colorado Requirements. Pages 3 and 4, “Ground Rules for Therapy” are a social contract between you and me and we each get a copy. The “Patient Easy Pay Plan and Consent” is required for all clients, including EAP. It is only used when you authorize me to use it (as for a copay) or for a no-show. Most insurances and EAPs do not pay for no-shows, so you are responsible for them. The next seven pages, starting with “Schedule of Additional Fees” and ending with “Practice Policy and Procedures,” require your signature. These include your rights and responsibilities and, if you need me in court, for depositions. Please fill out all requested information on the “Client Data Sheet” so I may contact you. The last five pages are a questionnaire and are optional, but I strongly recommend you fill them out as it will shorten the therapy work. I always read them. Thank you and I look forward to our collaboration.
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