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Creative Counseling and Coaching LLC

Client Forms

Instructions for new patients to include downloading the following forms and bringing them completed to first appointment if they have access to the Internet and a printer, this will save valuable time.

Client Intake Form

Information Sheet

Limits of Confidentiality

Outpatient services contract

Communications policy

Request for transmission of protected health information by non secure means  (if applicable)

Authorization for filing insurance

Acknowledgement of receiving this medical practices “ Notice of Privacy Practices”

Consent form

Notice of privacy practices (signed and received)

Teletherapy Clinical Service Consent

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information

Call Me Today

431 Post Road East Suite 14
Westport, CT 06880

(203) 675-3739

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