COUNSELING FORMS

New Client / Returning Client Paperwork (link)

The client must have an appointment first before submitting the intake/re-intake paperwork. Please select the intake paperwork that reflects the client's age or contact our office for assistance.

Adult Consent Forms

Clients are required to complete the general consent form prior to receiving services.

Minor Consent Form

Minor Consent Forms

To be signed by legal guardian/parents for/with minors (0-17).

Telemental Health (TMH) Informed Consent

Telemental: Consent

Holistic Elevation is offering Telemental Health (TMH) counseling services for clients, due to licensing restrictions. Information about Telemental Health is provided here, and for clients who desire to use the service, consent is required.

Notice of Privacy Practices and Disclosure Statement -

HIPPA Form

Use this form to to sign HIPPA

Authorization to Obtain/Disclose Information or Records

Release/Obtain Form

Use this form to authorize our office to release/request your confidential information or records to/from another person/organization.

Insurance Information

Insurance Verificiation

Use this form to submit insurance information, including a front and back copy of your insurance card.

Medication List Form

Medication List Forms

Clients are required to complete the Medication List form prior to receiving services.

Photos & Videos Authorization Form

Photo & Video Form

Use this form to submit insurance information, including a front and back copy of your insurance card.