My Documents | Sara Guy Counseling

My Forms

HIPPA Form

By law all clients are to receive a copy of their rights and HIPPA policies and procedures with any form of medical services provided.

Credit Card On File Form

As per my company policy all enrolled clients are required to place a card on file. This is a non-negotiable requirement.

Telehealth Consent Form

At times sessions are held via phone or video conference. This form discusses all aspects of completing sessions in a 'non-traditional' way. While it may not be your preferred method, it is still effective.

Intake - Minor

Clients under 13, parents and caregivers need to fill out. Adolescents 13 and older are welcome to complete as per Washington State Laws and Regulations. This form allows for me to gather all the needed information about your child for a proper and thorough assessment for diagnosis. This must be completed before the intake occurs as it will be reviewed during the intake appointment.

Intake - Adult

This form allows for me to gather all the needed information about you for a proper and thorough assessment for diagnosis. This must be completed before the intake occurs as it will be reviewed during the intake appointment.

Release of Information Form

Continuity of care is so important in this process. A release of information allows me to talk to your providers/caregivers/teams/school officials to allow the best therapeutic approach for your or your child's care. Even with a ROI signed, I will still inform you of any and all communications.

Minor Informed Consent

This form informs the client of the expectations, laws, rules and guidelines Sara Guy Counseling LLC intents to carry out. This must be completed before the intake occurs as it will be reviewed during the intake appointment. Once signed by all parties this is a binding agreement.

Adult Informed Consent

This form informs the client of the expectations, laws, rules and guidelines Sara Guy Counseling LLC intents to carry out. This must be completed before the intake occurs as it will be reviewed during the intake appointment. Once signed by all parties this is a binding agreement.