APPOINTMENT & CLIENT FORMS
APPOINTMENTS (complete the Appointment Request at the bottom of this page)
CLIENT FORMS (download, complete & return via email: Serving.LifeCare@gmail.com)
If you are a new client (17 years and older), please complete the following Adult Intake and provide to your counselor. ADULT Intake Form with Policies & Consents
If you are a new client (16 years and younger), please complete the following Youth Intake and provide to your counselor. YOUTH Intake Form with Policies & Consents
A copy of our Counseling Disclosure Information and Notice of Privacy Practices is provided for all clients to retain for their record: Limits of Confidentiality in Counseling
If you would like us to coordinate care with another provider (for example, your pastor, primary care physician, psychiatrist, etc.), complete this form to authorize release of counseling information: Authorization to Disclose Information
A copy of our HIPAA Notice of Privacy Practices is provided for all clients to retain for their record: HIPAA NOPP
Note: To download Adobe Acrobat Reader for free, click here.
CLIENT FORMS (download, complete & return via email: Serving.LifeCare@gmail.com)
If you are a new client (17 years and older), please complete the following Adult Intake and provide to your counselor. ADULT Intake Form with Policies & Consents
If you are a new client (16 years and younger), please complete the following Youth Intake and provide to your counselor. YOUTH Intake Form with Policies & Consents
A copy of our Counseling Disclosure Information and Notice of Privacy Practices is provided for all clients to retain for their record: Limits of Confidentiality in Counseling
If you would like us to coordinate care with another provider (for example, your pastor, primary care physician, psychiatrist, etc.), complete this form to authorize release of counseling information: Authorization to Disclose Information
A copy of our HIPAA Notice of Privacy Practices is provided for all clients to retain for their record: HIPAA NOPP
Note: To download Adobe Acrobat Reader for free, click here.
APPOINTMENT REQUEST
541.391.4322 and info@lifecarecounselors.com
To schedule an individual, children, couples, marriage or family counseling appointment or to obtain additional information about any of these counseling services, call, email or fill out the form below.
