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
File Size: 193 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
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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: 287 kb
File Type: pdf
Download File

Adult Information Sheet (18+ years of age)
File Size: 220 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
File Size: 179 kb
File Type: pdf
Download File

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