Breakthrough Counseling & Coaching
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  • Home
  • About
  • Services
    • Counseling
    • Coaching
    • Conflict Mgmt
  • Contact
  • Forms

New Patient Forms

New patients are required to fill out the new patient forms. Below are the forms in PDF format for you to download and fill out. PLEASE DO NOT EMAIL THESE FORMS DUE TO SECURITY. Please hand deliver the completed forms at your first session. If you would like to submit electronically, contact me for my secure email portal.
Informed Consent Policies
File Size: 96 kb
File Type: pdf
Download File

Client Information
File Size: 130 kb
File Type: pdf
Download File

HIPAA Notice of Privacy
File Size: 117 kb
File Type: pdf
Download File

Professional Disclosure & Policies
File Size: 97 kb
File Type: pdf
Download File

Covid Policy
File Size: 95 kb
File Type: pdf
Download File

Informed Consent for Treatment
File Size: 96 kb
File Type: pdf
Download File

Tele Mental Health Counseling Consent
File Size: 143 kb
File Type: pdf
Download File

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