LifeSpire, LLC
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  • Our Team
    • Nichole Nugent
    • Kristin Hollis
    • Brandon Stoothoff
    • Jamie Bolton
    • Office Manager, John
  • Services/Fees
  • Insurance
  • Contact
  • Forms
  • Locations
    • Camp Hill
    • Hershey
  • Home
  • Our Team
    • Nichole Nugent
    • Kristin Hollis
    • Brandon Stoothoff
    • Jamie Bolton
    • Office Manager, John
  • Services/Fees
  • Insurance
  • Contact
  • Forms
  • Locations
    • Camp Hill
    • Hershey
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YOUR CART

FORMS TO READ (4)
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 (last form listed) at your first appointment.
Consent Form
File Size: 200 kb
File Type: pdf
Download File

Full Version - Notice of Privacy Practices (NPP)
File Size: 308 kb
File Type: pdf
Download File

Brief Version - Notice of Privacy Practices (NPP-Brief Version)
File Size: 191 kb
File Type: pdf
Download File

Consent to Use and Disclose Health Information
File Size: 177 kb
File Type: pdf
Download File


FORM TO COMPLETE (1)​
After reading the documents above, COMPLETE the applicable form below, save it, and email it to [email protected] prior to your first appointment.  It is beneficial to each therapist if the form is received at least one day prior to your appointment.  However, 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 yrs of age)
File Size: 1190 kb
File Type: pdf
Download File

Adult Information Sheet (18+ yrs of age)
File Size: 439 kb
File Type: pdf
Download File


OTHER (1)​
Other Information to Read/Review (Do not complete without discussing with your therapist).  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.

Authorization Form
File Size: 189 kb
File Type: pdf
Download File

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