First Session Forms
Currently all sessions are being held via Telehealth. We utilize a secure, HIPAA compliant audio/video platform to connect. You can print these forms and scan to send to your counselor prior to your first session. You will also need to send a copy of your photo ID (Driver's License, Passport or Military ID) and a copy of the front and back of your insurance card. Please scan as one continuous document and send to: LivelyTherapy@protonmail.com
| intake_-_hipaa_form_livelytherapy.pdf |
| new_intake_dec_2021.pdf |
| intake_-_no_surprise_gfe.pdf |
| intake_-optional_release_consent_of_records_to_3rd_party.pdf |
| intake_-_emergency_contact.pdf |