Psychotherapy Forms for New Clients
You've taken the first step to speak with a JF&CS professional. Together, in a welcoming environment, client and clinician will map out a plan for treatment and measure progress toward attaining goals.
We want you to feel better.
Clinical Forms
Please view the links below and fill out the relevant forms before treatment. Confidentiality is strictly adhered to and nothing about you or your treatment will be provided to anyone without your written permission.
By clicking on a link you will be directed to a secure site to complete a form. Once a form is begun, it must be completed in its entirety. There is not an option to "Save" and return at a later time. Please allow enough time to complete the form. When all questions of a form have been completed, scroll to the bottom and click on "Submit."
Adult Client Forms:
1. Pre-admission Form
2. Personal History - Adult
3. Client Orientation & Privacy Notice
4. Treatment and TeleHealth Consent Form
5. PHQ9
6. Credit Card Authorization
7. Reminder Text Authorization
8. Authorization to Release/Request Information
9. Medication Management
10. Insurance Information Form
Children & Teens Forms:
1. Pre-admission Form
2. Personal History - Child
3. Client Orientation & Privacy Notice
4. Parent Authorization for Minor's Mental Health Treatment
5. PHQ9 - Parent/Guardian to fill out
6. Credit Card Authorization
7. Reminder Text Authorization - Child
8. Authorization to Release/Request Info
9. Medication Management
10. Insurance Information Form
11. Treatment Consent Form
12. Telemental Health Informed Consent Form.
13. Informed Consent for Interaction with the Legal System
Shalom Bayit Forms:
1. Client Orientation & Privacy Notice
2. Treatment and TeleHealth Consent Form
HAMSA Forms:
1. Client Orientation & Privacy Notice
2. Treatment and TeleHealth Consent Form
We are here. Let's talk.