LIFESPIRE, LLC
  • Home
  • OUR TEAM
    • Jamie Bolton, PsyD
    • Brandon Stoothoff, MS
    • Kristin Hollis, MSW
    • Nichole Nugent, MA
    • Office Manager, John
  • Services/Fees
  • Insurance
  • Schedule an Appt
  • Forms
  • LOCATIONS
    • Camp Hill
    • Hershey
  • Home
  • OUR TEAM
    • Jamie Bolton, PsyD
    • Brandon Stoothoff, MS
    • Kristin Hollis, MSW
    • Nichole Nugent, MA
    • Office Manager, John
  • Services/Fees
  • Insurance
  • Schedule an Appt
  • Forms
  • LOCATIONS
    • Camp Hill
    • Hershey
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YOUR CART

FORMS TO READ

Below you will find four various documents that you need to read before your first appointment.  This information will be reviewed at your first appointment at which time you can ask any questions about the forms.  Your therapist will have you electronically sign the Consent to Use and Disclose Health Information at your first appointment.
Consent Form (Read only - updated 1-9-20)
File Size: 256 kb
File Type: pdf
Download File

Full Version: Notice of Privacy Practices (Read only)
File Size: 878 kb
File Type: pdf
Download File

Consent to Use and Disclose Health Information (Read only)
File Size: 343 kb
File Type: pdf
Download File

Brief Version: Notice of Privacy Practices (Read only)
File Size: 443 kb
File Type: pdf
Download File


FORM TO COMPLETE

After reading the documents above, complete the applicable form below, save it, and email it to OfficeManager@LifeSpirePA.com prior to your first appointment.  Please note, email is not secure, so you may prefer to print and bring a completed hard copy form to your appointment instead.
Child Information Sheet (up to 17 years of age)
File Size: 862 kb
File Type: pdf
Download File

Adult Information Sheet (Ages 18+)
File Size: 665 kb
File Type: pdf
Download File


Other Information:  This form is used if you would like your care to be coordinated with your physician, psychiatrist, guidance counselor, teacher, counselor, pastor, or another professional.  Discuss with your therapist prior to signing.
Authorization Form (Read only)
File Size: 349 kb
File Type: pdf
Download File

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