303-801-7878 ♦ Video/TeleHealth Available Statewide-CO ♦ info@lifepathscounseling.com

Client Forms

Download Client Forms

LifePaths: Client Forms

Thank you for choosing to work with one of our counselors here at LifePaths.  Our forms are listed below, according to the services you will receive with us.

Please note that your forms must be completed before your first appointment with your counselor.  If you have any questions please get in touch with the counselor you are working with, or the Director, Cathy Wilson, at cw@lifepathscounseling.com or by phone or text at 303-801-7878.

Health Screening Form: Due to COVID-19, until further notice this form must be completed prior to any in-person session.  If your counselor does not receive it before your appointment, your appointment will be rescheduled and you will be charged the full fee for your session.  Click here to complete the form.

 

 

 

Forms for Individual Counseling – Adults

Disclosure and Consent (Required)

Intake (Required)

TeleHealth Consent or COVID-19 In-Person Consent (required according to how you are receiving services)

Release of Information (only when counselor requests)

Credit Card Authorization (Required)

Forms for Individual Counseling – Children and Teens

Disclosure and Consent (Required)

Parent Consent (Required from both parents/guardian)

Intake for ages 3-12 or Intake ages 13-17 (Required according to age)

TeleHealth or COVID-19 In-Person Consent (Required according to how you receive services)

Release of Information (only when requested by your counselor)

Credit Card Authorization (Required)

Forms for Couples Counseling

Disclosure and Consent (Required from both partners)

Intake (Required from both partners)

TeleHealth Consent or COVID-19 In-Person Consent (required from both partners, according to how you are receiving services)

Release of Information (only when counselor requests)

Credit Card Authorization (Required)

Forms for Boundaries of Steel Group with Traci Hart

Request to Join Group

Group Agreement (Required)

Surprise Billing Disclosure (Required)

TeleHealth or COVID-19 In-Person Consent (Required according to how you are receiving services)

Release of Information (Required to allow coordination of care with your individual therapist)

Credit Card Authorization

Forms for Teen Group with April Eavers

Request to Join Group

Group Agreement (Required)

Surprise Billing Disclosure (Required)

TeleHealth or COVID-19 In-Person Consent (Required according to how you are receiving services)

Credit Card Authorization

Forms for Boundaries of Steel Group with Jenn Bourdeon

Request to Join Group

Group Agreement (Required)

Surprise Billing Disclosure (Required)

TeleHealth or COVID-19 In-Person Consent (Required according to how you are receiving services)

Release of Information (Required to allow for coordination of care with your individual therapist)

Credit Card Authorization

Forms for Individual Counseling – Medicaid Members

Disclosure and Consent (Required)

Intake (Required)

Medicaid Member Rights (Required)

TeleHealth Consent or COVID-19 In-Person Consent (required according to how you are receiving services)

Release of Information (only when counselor requests)

Credit Card Authorization (Required)

 

 

Mental Health Assessments

 

OUR COMPANY

 

 

LifePaths Counseling Center

6901 S Pierce St #350

Littleton, CO 80128

303-801-7878

 

 

© 2016-2020 LifePaths Counseling Center

 

 

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