Individuals (18 years +) and Couples (completed by both partners):
- Notice of Privacy Practices (read only)
- Consent for Uses and Disclosures
- Informed Consent Form
- Informed Consent for In-Person Services During the COVID-19 Public Health Crisis (must be signed even if you are not currently receiving or intend to receive in-person services during the COVID-19 public health crisis)
- Informed Consent For Telemental Health Services (must be signed even if you are not currently receiving or intend to receive telemental health sessions)
- Client Information Form
- ROI Polaris to Others (only if you would like your counselor to communicate with a 3rd party about your treatment, i.e. pastor, attorney, primary care physician, school psychologist etc.)
- ROI Others to Polaris (only if you would like to a 3rd party to communicate with your counselor about your treatment, i.e. pastor, attorney, primary care physician, school psychologist etc.)
- Request For Non-Secure Communications (only if you wish to decline using the provided TheraNest Client Portal secure messaging to communicate with office staff and want to receive non-secure communications instead)
Children (17 and under):
- Notice of Privacy Practices (read only)
- Consent for Uses and Disclosures (if 12 or older client signs, if under 12 client and parent/guardian signs)
- Informed Consent Form (if 12 or older client signs, if under 12 client and parent/guardian signs)
- Informed Consent for In-Person Services During the COVID-19 Public Health Crisis (must be signed even if you are not currently receiving or intend to receive in-person services during the COVID-19 public health crisis-if 12 or older client signs, if under 12 client and parent/guardian signs)
- Informed Consent For Telemental Health Services (must be signed even if you are not currently receiving or intend to receive telemental health sessions-if 12 or older client signs, if under 12 client and parent/guardian signs)
- Client Information Form (if 12 or older client completes form, if under 12 client and parent/guardian completes form)
- Child Developmental History Form (parent/guardian completes form)
- Child Checklist of Concerns Form (parent/guardian completes form)
- ROI Polaris to Others (only if you would like your counselor to communicate with a 3rd party about your treatment, i.e. pastor, attorney, primary care physician, school psychologist etc.)
- ROI Others to Polaris (only if you would like to a 3rd party to communicate with your counselor about your treatment, i.e. pastor, attorney, primary care physician, school psychologist etc.)
- Request For Non-Secure Communications (only if you wish to decline using the provided TheraNest Client Portal secure messaging to communicate with office staff and want to receive non-secure communications instead)