Personal Growth

Better Quality of Life

Reduced Stress

Forms

We are here to help you. Select the appropriate forms and questionnaires to get started on the journey.
Our Privacy and Financial Policies are listed below under the "Privacy & Policies" header.

Telemedicine or technology assisted counseling (TAC) consent, policies, & agreement.

237Must be completed for ALL clients wishing to use technology assisted counseling. Please note that this document must be signed before counseling.

Please fill out to receive an email so you can digitally sign the document.

Registration Form

237 Must be completed for ALL clients

Important Signature Form

237Required for ALL clients

Adult Client Information

237Required for Adult clients

Parent Questionnaire

237To be completed by Parents of clients, age 17 and under

Services Provided to Minors

237To be completed by Parents of clients, age 17 and under

Adolescent Questionnaire

237To be completed by clients, age 12 to 17

Release of Information - General

237 Authorizes the exchange of protected health information between two parties

Release of Information - Primary Care Physician

237 Authorizes the exchange of protected health information with Primary Care Physician

Privacy and Financial 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.

Privacy Notice Policy

237 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

237Important information about CenterLife Counseling's Financial Policy

Important Information

237Information about your care and rights as a client at CenterLife Counseling

Easy Pay Information

237

Information about credit card processing at CenterLife Counseling