Integral Counseling Center, LLC


During our first session we will discuss and complete the following forms:
Client Rights Form: This form provides information to clients regarding client rights. Briefly, this form supplies information regarding the regulation of psychotherapy and guidelines of services such as: 1) Clients have the right to receive information about services provided, 2) Clients have the right to a second opinion, 3) Information discussed in session and all client files are legally confidential with a few exceptions, 4) How emergencies will be handled, 5) Fee and payment policy, and 6) Cancellation policy.
The Health and Insurance Portability & Accountability Act (HIPAA) form: This is the same form received from doctors, dentists, pharmacists, and any other healthcare providers. Essentially this form describes how medical information about clients may be used and disclosed and how clients can get access to this information.
Client Intake Form: The client and I will complete this form together. The form addresses general client information, (name, address, age, etc.) in addition to questions about health both physical and mental, family background, and other general history information.
Client Case Notes: These are brief notes I will complete at the end of each session. They will contain general information regarding the session such as topics discussed, observations, and plans for future treatment.
These are the majority of the forms and documents which will be maintained in each client’s file. These files will be kept looked at all times. I am the only person who has access to client files. There are certain exceptions to this which will be discussed during the first session.
Contact Information

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First Name:
Last Name:
Address Street 1:
Address Street 2:
Zip Code: (5 digits)
Daytime Phone:
Evening Phone:

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