Client Forms
Client Forms
One of the biggest setbacks for individuals seeking help in mental health is how complicated it feels.
For that reason, and many others, we have conveniently posted all our client forms here.
Please feel free to download a copy of each form and fill them out prior to your initial appointment.
Demographics Form
Demographics Form
This includes name, address, and insurance information.
HIPAA Form
HIPAA Form
Form designed to protect your personal information and medical records
Informed Consent and Payment Form
Agreement indicating insurance coverage and client financial responsibilities.
Contact and Cancellation Form
Contact and Cancellation Form
This form indicates which ways are best to contact you and at what times. Also included is our office cancellation policy.
Health History Intake Form
Health History Intake Form
This form helps us monitor medication changes and physical and mental health history. It will set a baseline for any changes you may be noticing while in our care and give insight into family history as well.
C. Card Authorization Form
C. Card Authorization Form
This is not a required form.
Please fill out if you prefer the office to keep a copy of your credit card of file for future appointments.
Release of Information Form
Release of Information Form
This is not a required form.
Please fill out if you need other members of your mental health team included in your care with Find Your Balance Counseling Group. This includes guidance counselors, medical professionals, as well as CMO.
E.S.A Emotional Support Animal Acknowledgement
E.S.A Emotional Support Animal Acknowledgement
This is not a required form.
Please fill out if you are aware of a limitation such as a fear or allergy that may negatively impact your ability to attend session with Find Your Balance.
Please speak to your counselor for additional questions or concerns.