Strong123.com

1 – BASIC FORMS

Before starting counseling, please complete the following 3 forms:

• Intake Questionnaire
• Release of Information
• Informed Consent – In Office

Please read the following information about Confidentiality:

• Notice of Privacy Practices

 

2 – ADDITIONAL SERVICES

If you intend to participate additional services, please complete the applicable forms (in addition to the first 3 forms):

• Informed Consent – Telemed
• Informed Consent – EMDR

 

3 – NEXT STEPS

Please bring your completed forms to your first counseling appointment.

• If you will be attending your counseling appointment via telemed, please send the completed forms (prior to your first appointment) via US Mail to: Susan Strong, PO Box 26033, Prescott Valley AZ 86312.
• Please protect your privacy by limiting your use of email and text services unless those services are encrypted and HIPPA compliant.
• If you experience any difficulty with accessing these forms, please leave a message on my confidential voice mail at 928-445-0055 regarding the difficulty.

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