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.
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 (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)
- Adolescent Questionnaire (To be completed by clients age 12-17)
- Telemedicine or Technology Assisted Counseling (TAC) Form (Signature)
- Generalized Anxiety Disorder Questionnaire (GAD-7) (To be completed by clients age 12+)
- Patient Health Questionnaire (PHQ-9) (To be completed by clients age 12+)
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