Forms

This form contains disclosures of Full Heart Therapy policies and procedures. Agreement to these policies and procedures is needed to begin counseling. After you’ve registered as a client in the scheduling system, you will receive a copy of this form via email. However, feel free to read and print from this page. All participating parties need to sign where appropriate. We will review this form, your questions, and concerns in your initial session. Copies are provided in the office if you are unable to print.

If you are attending Couples or Family Therapy, this form will be reviewed and signed by all attending parties in the initial session.

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 bring to session.