Brenda Sallee

brenda@lifesongcounseling.com

850-293-0031

1301 E. Gadsden St.

Pensacola, FL 32501

Forms are available for you to print and complete prior to your first session, or please plan to arrive 15-20 minutes early to complete them in the office upon arrival.

Counseling Informed Consent Form

The informed consent forms are required by law to be completely filled out, signed, and verbally reviewed between client and therapist before the first session can begin. It serves to make sure every client has been informed about the therapist, the benefits and risks of therapy, and the specific instances in which confidentiality must legally be broken.

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Consent to Fees

Please complete prior to first session.

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Adult Intake Form

This form must be completed by each adult who will be in a session. It is important that the therapist has this information for the first session. Some questions may seem irrelevant, but please complete the entire form.

Please note: Minors require a different for which you can find below.

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Child/Adolescent Intake Form

This form must be completed by a parent or guardian for each minor who will be in a session at LifeSong Christian Counseling. This information tells the therapist very important and must be available to the therapist by the beginning of the first session.

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Child/Adolescent Consent to Treatment

In order to treat any minor, parents/guardians must provide consent for therapy. In addition, the therpist must be informed of the confidentiality, or lack thereof, about their minor's sessions. Typically minors will be much more open if their parents will not be told everything discussed in counseling, however it is up the the parents/guardians to make that decision and inform the therapist.

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HIPAA Privacy Authorizarion Form

The HIPAA Privacy Authorization is necessary if you wish to have any of your clinical notes and/or information released to or from LifeSong Christian Counseling to anyone. Your information is held confidentially and will not be released until or unless this form is signed, specifying who is allowed access to your information.

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