Counseling Forms
If you do not have the option to print the forms below, they will be mailed to you. Intake forms must be received before telehealth appointment or bring them with you upon arrival to your in-person appt. If I do not receive your packet via mail before your telehealth appointment, your appointment will be rescheduled.
All forms are necessary except the following optional/as-needed forms:
Form 2.1 - Self-Pay Auth. (do not print this form if you are utilizing your insurance).
Form 8 - Records Release, as needed
Form 9 - Non-custodial parent release
If you are computer savvy, you can download the forms below, print, sign and return them back to me at:
evolvecounselingoflansing@gmail.com prior to your online appointment or you may bring them with you to your in-person appt.
All forms are necessary except the following optional/as-needed forms:
Form 2.1 - Self-Pay Auth. (do not print this form if you are utilizing your insurance).
Form 8 - Records Release, as needed
Form 9 - Non-custodial parent release
If you are computer savvy, you can download the forms below, print, sign and return them back to me at:
evolvecounselingoflansing@gmail.com prior to your online appointment or you may bring them with you to your in-person appt.
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See below for the DISCLOSURE STATEMENT and NOTICE OF PRIVACY PRACTICES for Evolve Counseling and Holistic Wellness, LLC. This serves as your formal electronic notice. Should you wish to have a paper copy of this notice, please request one during your appointment. You may need to view these forms in Desktop mode. Updated: 2/28/2021