Client Forms

Clients:

If you’re a new client, please complete the following forms and bring them to your first appointment.

• Intake-Insurance Coversheet
• Informed Consent
• Minor Informed Consent
• Informed Consent for Telehealth
• Consent For Treatment
• Client Rights
• HIPPA Notice of Privacy Practices
• Cancellation Policy

If you would like us to coordinate care with another provider (for example, your case manager, psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

• Authorization to Disclose Information Form

Providers:

If you’re a provider requesting services for your patient or client, please complete the following form and forward to us by:
Email (referrals@ChoicesSC.com) or Fax (803-851-3956).

• Referral Form

Workshop Registration:

• Registration Form

Note: To download Adobe Acrobat Reader for free, click here.

To Schedule an Appointment:

To schedule an individual, children, or family therapy appointment or to obtain additional information about any of these counseling services, please fill out this form or give me a call.

 

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