Forms

“From a small seed a mighty trunk may grow.” ~ Aeschyus

 

Taking the first step toward a healthy mind.A necessary step …

You can print these and complete prior to your 1st session

– OR –

Arrive early to your session and complete these in our facility

 

 

 

DJ Big Notice of Private Practices & Information

DJ Financial Form

DJ Information Sheet

DJ Informed Consent Form

DJ Letter of Notice of Private Practices

DJ Release of Information

DJ Insurance Form for Billing

DJ Statement of Professional Disclosure

 

 Licensed Professional Counselor - Dianna Jurena