Forms

Forms.jpgThroughout your time at LifePointe Counseling, LLC you will need to fill out a variety of forms.  Some of these forms are mandatory, such as the registration and client questionnaire paperwork. Other forms are optional and/or related to specific issues you may encounter.

 

For your convenience, we have organized these forms by topic with a designation as to whether they are mandatory or optional.  Most clients prefer to print these documents at home and bring them in to their health care provider, but we also have hard copies available upon your request in our office.

BlueDividerGreenDiamond

New Client Paperwork

Before you obtain treatment from a provider at LifePointe Counseling, LLC, you will need to complete some basic mandatory paperwork. You may print and complete the New Client Packet and the Client Questionnaire prior to your first appointment and bring these documents with you to your appointment.  Legally we have to provide you with our HIPAA, Notice of Policy Privacy, and Client Rights documents.  If you would like to save computer ink and paper, you may simply print the “New Client Packet – Printable/Without HIPAA” document listed below, then simply read our “Notice of Policy Privacy and Client Rights”.  Or, if you prefer, you may come to your appointment 15-20 minutes early and fill out these forms in our office.

 

BlueDividerGreenDiamond

Financial Forms (Optional)

Whether you plan to use your insurance or pay privately for our mental health services, the forms below serve to clarify our financial policies and procedures.  We encourage you to read our Financial Policies document prior to your first visit.  If you would like to pay for our services by credit/debit/HSA card and would like to leave your payment information on file, you may print and complete our Credit Card Authorization form.  If you are submitting a request for sliding scale fees, please review the Sliding Scale Table document and complete the Financial Disclosure Form.  Please note that not all of our health care providers provide sliding scale rates.  If you have any further questions, please contact our front office at 314-849-2120.

BlueDividerGreenDiamond

Consent Forms

Consent forms are optional for you to fill out.  Providing us with a completed Authorization For Disclosure form allows us to legally coordinate care with other health care providers, such as your general physician or previous mental health providers.

BlueDividerGreenDiamond

Insurance Forms

  • Your Insurance: What You Need To Know – Coming Soon!

BlueDividerGreenDiamond

Marketing Documents