new client information/forms

First appointment and what to expect

Below you will find directions for your first appointment.  If you have any questions, please discuss them with your counselor.   Our counselors are all independent practitioners, which means that they are not all on the same insurance panels and some of them do not accept insurance plans.  It is your responsibility to call your insurance company to determine your mental health benefits.

We are honored that you have chosen to allow us to serve you, and look forward to meeting you.

  • If you are an adult: 
    1.  Complete the online registration in Therapy Appointment for your counselor
    2.   Schedule your appointment (you may need to first contact/email the counselor to make sure that it is the right fit prior to scheduling)
    3.  Complete the biographical information in Therapy Appointment
    4.  Print, read and sign the Authorization to Treat/Professional Disclosure Information  Consents.3.2017adult
    5.  Please read our HIPPA  Notice of Privacy Practices – HIPPA NOTICE OF PRIVACY PRACTICE.2016
    6.  Bring your insurance card (if you are using insurance*), your driver’s license and a credit card or flexible spending card/health savings account, a list of your medications and all completed paperwork.
  • If you are scheduling an appointment for your child or teenager:
    1.  Complete the online registration in Therapy Appointment for the counselor you would like for them to see
    2.  Schedule your appointment (you may need to first contact/email the counselor to make sure that it is the right fit prior to scheduling)
    3.  Complete this form for your child if they are 12 or under – Parent of Child Questionnaire
    4. Complete this form for your teen Parent of Teen Questionnaire
    5.  Print, read and sign the Authorization to Treat/Professional Disclosure Information Consents.01.2017.b.child.teen
    6.  Please read our HIPPA  Notice of Privacy Practices – HIPPA NOTICE OF PRIVACY PRACTICE.2016
    7.  Bring your insurance card (if you are using insurance*), your driver’s license and a credit card or flexible spending card/health savings account, a list of your child’s medications and all completed paperwork.

Other Forms

  • Release of Information – This allows your counselor to release information or talk to another person (your doctor, your child’s teacher, etc)  blank roi

 

 

 

in Lee's Summit Missouri.