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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 Flyer2023-2024

Spiritual Direction Application Form 2023-2024

 

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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