Forms

Welcome. Thank you for your interest in counseling at LifeSpanCounseling. Attached below are the client forms relevant to your first session. You need only bring the Registration Form and Consent Form forms to session unless you have questions about the Notice of Privacy Practices or the Office Policies.

When you arrive at the building, please come to the second floor and let the receptionist know you are a new client. If for some reason you do not have these forms with you, please let her know and she will give you a set to complete before your session. Please also bring your insurance card and authorization code if applicable. The receptionist will call me to come greet you.

In response to the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Public Law 104-191, the United States Department of Health and Human Services published a regulation in the form of the Privacy Rule. This rule, as updated in 2013, results in requirements that include:

• A covered health care provider with a direct treatment relationship with individuals must deliver a privacy practices notice to patients
• A covered health care provider with a direct treatment relationship with individuals must make a good faith effort to obtain written acknowledgement from patients of receipt of the privacy practices notice