Document with Pen

Client Documents

Please download and sign all documents. All documents must be returned to Massengale Counseling prior to the first session.

 

Consent to Telehealth Services

This form gives me permission to provide services through a third party videoconferencing platform.

Consent to Treatment

This document gives me permission to provide services to you, such as clinical counseling.

Client Registration

This form provides me with your identifying information, such as name, age, date of birth, and other items.

Pending

HIPAA & Privacy Practices

This form provides you with all the legal information surrounding your personal information and how it will be maintained.

Pending

Practice Policies

This form explains other aspects of our encounters including canceling sessions, no-show fees, social media, and other telecommunication.

Pending

Release of Information Consent

Please use multiple copies for multiple releases. This form provides me with permission to release specific documents or communicate with specific individuals about your treatment.

Pending