At LifePointe Counseling and Psychiatry, you will need to fill out a variety of forms. Some of these forms are mandatory, such as the registration. 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 the completed forms with them on their first visit. However, we also have hard copies available upon your request in our office.

Financial Forms

Whether you plan to use your insurance or pay privately for our 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 will be paying for our services by credit/debit/HSA card, it will be required to have one of these cards on file with our office. This simplifies paying your co-pay or if there is a charge for a missed appointment or late cancellation.  Missed appointments and late cancellations should be part of your first session discussion.  If your provider does not bring it up, be sure and ask.  If you are submitting a request for sliding scale fees, please review the Sliding Scale Table document and complete the Financial Disclosure.  If you have any further questions, please contact our office at 314-849-2120.

Credit Card Authorization

Financial Disclosure

Financial Policies

Sliding Scale Table

New Client Paperwork for Children & Teens:

There is an intake form titled “Informed Consent Form for Minors” that we ask each prospective client’s legal guardian(s) to complete prior to the minor’s initial appointment (this is in addition to our standard registration packet, which you can access here).

You can access this form here: Informed Consent Form for Minors.

We strongly recommend you fill out this form ahead of time so that you have time to attain the information required for the provider to see your child or teen.

If you are unable to complete the packet beforehand, please plan to arrive 20 minutes early so that this packet can be completed without interrupting session time. Blank packets will be printed on colored paper and located on clipboards in our office lobby.

New Client Paperwork

New client paperwork is mandatory. Legally we have to provide you with our HIPAA, Notice of Policy Privacy, and Client Rights documents. Or, if you prefer, you may come to your appointment 15-20 minutes early and fill out the new client registration paperwork in our office.

New Client Packet – Printable

Client Questionnaire

Notice Of Privacy Practices & Client Rights

Life History Questionnaire (Lanny McFarland clients)

Consent Forms

Consent forms are mandatory to fill out if you desire your provider to legally coordinate care with other health care providers, such as your general physician or previous mental health providers.

Authorization For Disclosure