FORMS
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.
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COMPLETE: After reading the documents above, complete the applicable form below, save it, and email it to LifeSpire@verizon.net 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) |
| Adult Information Sheet (Ages 18+) |
GROUP THERAPY FORMS: Participants should complete pages 1 & 2 of the Group Therapy Information Sheet and parent/guardian should complete pages 3 & 4. Both participants and parent/guardian must review the Group Therapy Contract prior to the intake as the participant will need to sign it at the intake.
| Group Therapy Information Sheet (Complete) |
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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. You can look at this form now so you are familiar with what you will sign before any information is released about you.
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