Fee & Policy, Intake & Consent Forms
The Fee & Policy Information is the same as the Office Information page of this website. Your signature will confirm you have read and agree to abide by the policies of LifeChange, LLC.
The Intake Form requests basic information about you and the reason you’re seeking psychotherapy. The more detailed information you provide, the more it will facilitate our initial evaluation session.
The Teletherapy Consent Form enables our working via video-conferencing, and the HIPAA Form allows for our communicating electronically.
If you have scheduled an appointment, please read, sign and email all four forms back to [email protected] before our first session.
(PDF file, free Adobe Reader required)
The Intake Form requests basic information about you and the reason you’re seeking psychotherapy. The more detailed information you provide, the more it will facilitate our initial evaluation session.
The Teletherapy Consent Form enables our working via video-conferencing, and the HIPAA Form allows for our communicating electronically.
If you have scheduled an appointment, please read, sign and email all four forms back to [email protected] before our first session.
(PDF file, free Adobe Reader required)
| 2024_fee___policy_sheet.pdf |
| 2024_updated_intake_form.pdf |
| 2024_teletherapy_consent_form_.pdf |
| 2024_hippa.pdf |