Forms

The Consent For Services Form contains disclosures of Full Heart Therapy, LLC by Andrea Nus, LMFT member, policies and procedures. Agreement to these policies and procedures is needed to begin therapy. After you’ve registered as a client in the scheduling system, you will receive a copy of this form via email. All participating parties need to read and sign the document to participate in therapy. We will review this form, your questions, and concerns in your initial session.

If you want Couples Therapy, this form must be reviewed and signed by all attending parties.

Health Insurance Portability and Accountability Act of 1996 (HIPAA) is United States legislation providing data privacy and security provisions for safeguarding your medical information. By signing the Consent for Services, you are agreeing you have read and received this information regarding your rights as a client. You do not need to print or sign this document.

Telehealth (online) sessions are conducted through doxy.me/andreanus. This form explains the risks of telehealth. Please read, sign and date, and send to me prior to our initial session. If you have questions or concerns regarding telethealth, please contact me prior to or in the initial session.

The Insurance Questionnaire/Confirmation of Benefits form assists you in asking your Insurance Provider questions to determine if you want to work with me, based on your circumstances. I am happy to assist you in understanding what the questions/answers mean for you and your circumstances so you can make an informed decision.