INTAKE FORMS AND ADDITIONAL FORMS

These forms may be useful in advancing your treatment

Client Intake Form

Telehealth Consent Form

Formulario de Admision del Cliente

Formulario de Consentimiento de Telesalud

Release of Information

Autorization Para Devulgacion de Informacion

Formulario de Salud Mental

Child & Teen Form

Adult Intake Form

Sensory Room

Consent for Billing

Credit Card Authorization Form

If you would like to pay by credit card, you will need to fill out this form. You can pay via credit card as a single-time occurrence or on a continuous basis. You will need to fill out this form again only if you change the frequency of credit card payments or if your credit card information changes. 

Release of Information

By filling out this one-page form, you are authorizing Mindsolutions, LLC to consult with other people, whom you specifically select, about your treatment (e.g., physicians, lawyers, school personnel, family, etc.). You and your therapist would decide the nature of the information discussed with these other people before he/she initially consults with them. Consultation with anyone other than the person or people in treatment cannot occur without this written consent.

For Informational Purposes Only

Practice Guidelines and Policies

FOR INFORMATIONAL PURPOSES ONLY. You may read this form online or print out a copy for yourself, but you do not need to bring it in or give it to your therapist. We will review the information in this form verbally at the beginning of your first session

HIPAA Privacy Notice

FOR INFORMATIONAL PURPOSES ONLY. You may read this form online or print out a copy for yourself, but you do not need to bring it in or give it to your therapist. We will review the information in this form verbally at the beginning of your first session.