Informed Consent Agreement for Minors:
Please complete the form for the therapist you are scheduled to see!
Please complete the form for the therapist you are scheduled to see!
| Ingrid Higgins, MFT |
| Stephanie Chase, MFT |
| Jessica Peters, MFT |
| Darice Funk, MFT |
Informed Consent for Adults:
| Ingrid Higgins, MFT |
| Stephanie Chase, MFT |
| Jessica Peters, MFT |
| Darice Funk, MFT |
Intake Form:
| Intake Form Adult |
| Intake Form Child |
Release of information:
| Authorization to Exchange Information |
Credit Card Authorization:
Have a teen who will be driving them self to therapy? We can keep a card on file, so they don't have to remember to bring payment anytime! If you choose to do this, please complete the form and email or fax it to your therapist.
Have a teen who will be driving them self to therapy? We can keep a card on file, so they don't have to remember to bring payment anytime! If you choose to do this, please complete the form and email or fax it to your therapist.
| Credit Card Authorization |
