Forms for Counseling
Please print and complete forms 1-6 below and bring them with you to your appointment. If you need your records released for any reason, please also print and complete Form 7. If you are unable to print and complete these forms, please plan to arrive 15 minutes early to complete paperwork.
Please bring your insurance card and photo ID to your appointment.
Please bring your insurance card and photo ID to your appointment.
| 1_consent_for_outpatient_services.pdf |
| 2._insurance_authorization.pdf |
| 3._cancellation_policy.pdf |
| 4._general___medical_information.pdf |
| 5._notice_of_privacy_practice_-_receipt.pdf |
| 6._informed_consent_regarding_insurance_and_payments.pdf |
| 7_authorization_to_release_information.pdf |
See below for the NOTICE OF PRIVACY PRACTICES AND DISCLOSURE STATEMENT 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.