A description of the forms are listed below. Please complete one copy of each form instructed to you by your therapist to bring with you to your first session. If you are seeking premarital/marital counseling, each partner must complete a psychosocial history form. If you are a distance counseling client, please email the forms prior to your first session to firstname.lastname@example.org.
Intake history for individuals and families.
Intake history for couples.
This forms acknowledges that you have received a copy of the Notice of Privacy Practices, and that you understand we can use your Protected Health Information for treatment, payment and operations.
HIPAA & HB300 regulations and our professional code of ethics both require that NewBeginnings | FreshStart Counseling Group (NBFSCG) keep your PHI private and secure.
You have the right to request how you choose for New Beginnings | Fresh Start Counseling Group to communicate with you regarding your financial and/or medical information. The Health Insurance Portability and Accountability Act (HIPAA) protects your privacy so that your information is communicated to you by the method of your choosing.
Please select the file(s) below to bring to your first session. If you have any questions, please contact your therapist for further information or call our office.