Clinical Paperwork
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. 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".
Packet 1 link below includes:
Client Orientation
Notice of Privacy
PHQ9
Packet A:
Treatment Consent Form
TeleMental Health Informed Consent
Packet B:
PHQ9
Packet 2 link below includes:
Informed Consent for Interaction with Legal System Parent Authorization for Minor's Mental Health Treatment
Packet 3 link below includes:
Authorization to Release/Request
Packet 4 link below includes:
Credit Card Authorization
Clinical Paperwork
- Pre-Admission form
- Personal History Form (Adult)
- Client Orientation and Privacy Notice
- Treatment and Telehealth Consent Form
- PHQ9
- Credit Card Authorization Form
- Authorization to Release/Request Information
- Personal History Form (Child)
- Consulting Physician Agreement
- Insurance Information Form
- Reminder Text Consent Form - Adult
- Reminder Text Consent Form - Child