$150.00 for Each Set of Paperwork
Whether you have owned a practice for many years or are considering starting your own, paperwork that is up to date, HIPAA compliant, and protects your practice from ethical concerns is essential for working with clients.
Each set of paperwork has been compiled, developed, and continually revised since 2007 when Dr. Johnson began the Center for Counseling and Family Relationships. All documents included in the portfolio are sent electronically in Microsoft Word documents.
Starter Set One for Clients:
Our Intake Paperwork
Our Intake Paperwork includes:
Insured’s Information and How to Check Benefits
Cancellation Policy and Credit Card Information
Our Fee Policy
Assignment of Benefits
Limits of Confidentiality
Acknowledgement of Review of Privacy Practices
Our Policies and Procedures
This two-page document includes how we handle:
No-Shows, Late Cancellations, and Scheduling
Late Arrival and Scheduling
Balances and Credits
Parent Updates Before child Sessions
Release of Information
Limits of Confidentiality
Notice Of Privacy Practice:
This form includes HIPAA and PHI information for CCFAM as required by law.
Release of Information for Adult
This form is a standard release for an adult client including: who to release to, information to release, the purpose of the release, and the ability to revoke consent.
Release of Information for a Minor
This form is a standard release for a Minor Client including: who to release to, information to release, the purpose of the release, and the ability to revoke consent.
Advanced Set Two for Clients:
First Appointment Checklist
This checklist is one page and goes through all the details and reminders of what a client needs to know and paperwork to bring to their initial appointment, including arranging childcare for their children and custody paperwork for minor children.
Parent Letter of Participation
When required by divorce decree, this form about our practice is given to the Custodial Parent, who has sought counseling for their child, to share with the child’s other Custodial Parent, who needs to be informed of counseling.
Checklist of Concerns for Child
This checklist is one page and includes concerns of parents and allows them to select symptoms and behaviors of their child. It also includes questions about exercise, sleep, screen time, and devices.
Client History for Teens Only
This history form is several pages and includes the teen’s perspective on:
the need for counseling
medical and behavioral symptoms they are concerned about
information about their family
alcohol and drug history
school and friends
daily life (exercise, sleep, screen time)
Checklist of Concerns for Adult
This checklist is one page and includes: medical and behavioral symptoms along with questions about exercise, sleep, and screen time.
Adoption Background Information
This form is one page and includes questions about the Birth Family and the openness of the adoption.
Foster Care Background Information
This form is two pages and includes Birth Family History and Foster Care Placement History.