INSURANCE OR EAP PAPERWORK

• Consent
• Psychosocial
• HIPPA
• Insurance Newsletter
• Custody Paperwork (Please complete if under 18)
• Release of Information
  • Please complete this form if you are doing couples therapy. Please write in the “Agency/Person” box your partner or spouse.
  • Please complete this form if you would like us to coordinate care with a medical provider, school counselor, teacher, or other supporting individuals.

ADJUSTED FEE APPLICATION PAPERWORK

• Consent
• Psychosocial
• Adjusted Fee Application (Please also attach last years tax return or two recent W-2 paystubs)
• HIPPA
• Custody Paperwork (Please complete if under 18)
• Release of Information
  • Please complete this form if you are doing couples therapy. Please write in the “Agency/Person” box your partner or spouse.
  • Please complete this form if you would like us to coordinate care with a medical provider, school counselor, teacher or other supporting individuals.

Please email the paperwork to lifeworks@lifeworks-counseling.org or jbehling@lifeworks-counseling.org or chawks@lifeworks-counseling.org