Forms

Please print and complete the below forms and scan and return signed forms to tracival@outlook.com or bring to your first session. In addition, if you’re seeking couples counseling, please see below for the Couples forms, to be completed by each partner.

Client Registration Fillable Form – Client Registration Fillable form (pdf)

INSURANCE Client Registration Form 

Privacy Practices (HIPAA) –  Download (pdf)

Observation Sessions – Download (pdf)

Informed-Consent_(fillable pdf)

Telehealth Informed Consent (fillable pdf)

Sessions Report Form 10-2010

Medical Billing Contract 6%

Information Necessary For Set Up

Couples Only

Couples Satisfaction Checklist – Download (pdf)

Couples Questionnaire – Download (pdf)