Intake Procedures for Child and Family Counseling Center

This page will explain our intake procedures.  Please call our office to schedule an initial appointment.   Before your appointment, call your insurance company to check on your mental health benefits.  You will want to know before you come in if your insurance will cover part of your visit.     Be sure to ask who manages the mental health benefits, because it may be different from the insurance plan listed on your card. If we are not providers for your insurance, find out if you have any out-of-network benefits. 

You should ask the following questions and be prepared to provide this information at your intake appointment:  

1) What is my copayment? 2) Do I have to have a deductible to meet before my insurance company will start paying?  If so, how much is it and has it been met?  3) Do I need preauthorization?  

Be sure to bring your insurance card to your first appointment.  The secretary will need to make a copy of the card.  If you (or your child) has had prior psychological testing, please bring copies of these reports to the first appointment for the therapist to review.  If you (or your child) has had prior therapy or been prescribed psychiatric medication, it would help us greatly if you can provide us with the names (and addresses or phone numbers if you have them) of prior therapists.   We will need you to sign a release of information so we can contact them should the need arise.  

The following are some of our intake forms, along with information about our practice.  Printing them out and completing them ahead of time will help save time at the initial appointment.  Please arrive 5-10 minutes early for your first appointment to give the secretary a chance to check you in, copy your insurance card, and have you sign a financial agreement, as well as other paperwork if you have not printed out and signed them ahead of time.  If you complete the HIPAA forms ahead of time, PLEASE read our HIPAA policies carefully, as they contain important information about the limits of confidentiality.  This form must be signed before your therapist sees you .  Be sure to ask your therapist if you have any questions about confidentiality.

If you have any questions, please don't hesitate to call us.  The following forms are all PDF files.  

Intake Forms                                                                   Practice Forms

DIRECTIONS to our office                                                 Office Procedures

Patient Registration Form          

Lifetime Payment Agreement                                               Guide to Counseling and Psychotherapy

HIPAA Policy and Consent Form                                        Guide to Couples Counseling

Child and Adolescent History Form

Adult History Form

Release of Information Form  

(For the Release of Information form, please print one out for each person you would like us to contact.  Insurance companies require that you sign a release for your primary care physician, though you can check the "do not authorize" line if you do not want your therapist to contact your physician.)

Updated: 4-2-09