Personal Growth

Better Quality of Life

Reduced Stress

Adult Forms

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.

Additional Forms

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.

Privacy Notice
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