Telemedicine or technology assisted counseling (TAC) consent, policies, & agreement.
Must be completed for ALL clients wishing to use technology assisted counseling. Please note that this document must be signed before counseling.
Registration Form
Must be completed for ALL clients
Important Signature Form
Required for ALL clients
Adult Client Information
Required for Adult clients
Parent Questionnaire
To be completed by Parents of clients, age 17 and under
Services Provided to Minors
To be completed by Parents of clients, age 17 and under
Adolescent Questionnaire
To be completed by clients, age 12 to 17
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 Notice Policy
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).
Financial Policy
Important information about CenterLife Counseling's Financial Policy
Important Information
Information about your care and rights as a client at CenterLife Counseling
Easy Pay Information
Information about credit card processing at CenterLife Counseling