Better Quality of Life
Please fill out the forms below. Back to main Forms Page.
Our Privacy and Financial Policies are listed below under the "Privacy & Policies" header.
- Registration Form (Signature)
- Important Signature Form (Signature)
- Services Provided to Minors (Signature) (To be completed by Parents of clients age 17 and under)
- Parent Questionnaire (To be completed by at least one parent)
- Telemedicine or Technology Assisted Counseling (TAC) Form (Signature)
Release of Information - General
Authorizes the exchange of protected health information between two parties
Release of Information - Primary Care Physician
Authorizes the exchange of protected health information with Primary Care Physician
Privacy and Policies
Below are important policies and practices of CenterLife Counseling. Please contact us if you would like more information about any of them or about the clinic.
The privacy of your health information is important to us. We are required by law to protect the privacy of your health information and to give you notice of our legal duties concerning "Protected Health Information" (PHI).
Important information about CenterLife Counseling's Financial Policy
Information about your care and rights as a client at CenterLife Counseling
Easy Pay Information
Information about credit card processing at CenterLife Counseling