To Fill Out Before You Come

Paperwork

The following forms are for you to look over and sign prior to the initial assessment.  Obviously, if you have any questions about any of these forms, please let us know. 

Brochures

About Play Therapy

Making Sense of Filing Out-of-Network

Glori Gray, MSW, LCSW

Wendy Pocock, MACC

Consent Forms (Under 18)

Emergency Consent

Release of a Minor

Consent Forms (For All)

Appointment Cancellation Policy

Authorization to Release Information (to share with collateral resources)

Inside Out Policy Statement

Insurance Filing Form (Only if you are going to be filing insurance)

Notice of Privacy Practices

Receipt of Privacy Practices (Please make 2 copies, 1 for you to keep)

Treatment Contract

Consent Forms (For Adults)

Adult Intake Form