Client Forms

Since transitioning to remote work in March 2020, as a result of COVID-19, we have shifted our paperwork to be more contactless, electronically efficient, and promote a paperless 'footprint'. We now send all of our clients' forms via email for electronic completion, which would typically be required to complete in-office. Our system will allow you to provide the necessary information for scheduling, updates, authorizations, and other such needs, securely and all at once.
 
The documents will come from “Adobe Sign” using the email address echosign@echosign.com. Be sure to check your junk/spam email boxes if you do not find them in your regular inbox. You will be able to review, initial and sign the forms almost immediately, the form(s) must be returned electronically through the process in which they are received for an e-signature audit report to be established for our records. Forms should not take more than 10-15 minutes to complete. 

Our forms are designed to be inclusive for clients of all ages/gender/preferences/etc. If the line items do not pertain to you, then you can simply skip over them.

New Client Paperwork, Quick Reference: 

  

  • Intake Form, page 1 "New Client Demographics Form"

    • Complete required sections applicable to you/your child

    • Read & initial the authorization items at the bottom

    • Sign & date

  • "Guidelines & Policies"

    • Review pages 1-3

    • On page 4, read & initial each of the acknowledgment

      • Skip the "personal representative section", if you are not completing the forms on behalf of the client/minor

      • For section "Treatment Authorization", write your name on the authorization line and indicate whom services are authorized for

    • Sign & Date

  • "Financial Policy"

    • Review the upper portion of the form

    • Read & initial the authorization items at the bottom

    • Sign & print name, date & indicate relationship to the client

  • "Teleconsent"

    • Review & initial each section

    • Sign & print name, date & indicate relationship to the client

  • "HIPAA", a standard copy given by all medical offices for your records

  • Provide a copy of the front & back of your insurance card(s) and your (or parents, if the client is a minor) drivers license/ID via email or fax  

Existing Clients, Additional Forms:

 

  • "Release of Info (ROI)", can be used, for example, to authorize communications between providers in/out of our group, request records, authorize communications with parties pertaining to financial matters, and such.

  • "Client Information Update Form", to be used when clients demographic &/or insurance(s) change. If changes in insurance, be sure to provide a copy of the front and back of the new insurance card(s) our records. The card copies can be emailed, faxed, or uploaded via our secure upload feature through our website.

  • "Credit Card Authorization Form", can be completed to leave a credit card payment method on file for processing.

Established clients requesting form(s):
Contact Christine via email by clicking here, be sure to advise the necessary form(s) you need to be provided. The forms will be emailed to you through our secure electronic document server for completion.