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Forms

Intake forms: Acupuncture

Informed Consent For Therapy Services

Consentimiento para Servicios de Acupuntura

Body Center Appointment Policies

Acupuncture Confidential Information Form

Acupuntura Formulario Confidencial

 

Intake Forms: Psychotherapy

HIPPA Privacy Form

Authorization for Release of Information

Informed Consent for Therapy Services

Therapy Intake – Client Confidential Information Form

Consent for Psychological Testing

 

 

Spiritual Direction Forms

Spiritual Direction Confidential Information Form

Spiritual Direction Flyer2021

Spiritual Direction Application Form 2021

 

Parish Counseling Client Forms

Individual Client Questionnaire 5.17: filled out before third session. (PDF)

Couples Information Questionnaire 5.17: before third session. (PDF)

Notice of Privacy Practices: (Hippa Info) given to client at first meeting. (PDF)

Privacy Consent Form: (Hippa Signature Page) signed by client, handed into office. (PDF)

Informed Consent: given to client at first meeting (PDF)

Informed Consent Signature: signed by client, handed in to office. (PDF)

 

The Claret Center
5536 South Everett
Chicago, IL 60637

p: 773.643.6259
f: 773.643.6929

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