Thrive Counseling + Consulting, PLLC

Client

Forms

Notice of
Privacy Practices

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About

This form is a resource to you. It informs you of Thrive's Privacy Practices and how Thrive utilizes your protected health information. 

This form is a requirement.

What to do with this form
-Review it
-Ask questions, if needed
-Refer to it later as needed

Informed Consent


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About

This form informs you about confidentiality, the nature of therapy, and other policies and procedures that you need to know about as a client.

This form is a requirement.

What to do with this form
-Print
-Review it
-Ask questions, if needed
-Initial and sign where indicated on pages 1 & 2, return to Thrive or bring with you to initial session
-Refer to it later as needed

 

Authorization to Release Information

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About

This form gives Thrive permission to discuss your care with others. This is required if you would like Thrive to consult or collaborate with other professionals or treatment team members (e.g., psychiatrist, dietitian, etc.) or family members if you are an adult.

This form is a requirement.

What to do with this form
-Print
-Review it
-Ask questions, if needed
-Fill in information and sign where indicated
-Return to Thrive or bring to your next session

Phone Coaching Worksheet

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About

This form is a worksheet for you to use outside of session and before you reach out for phone coaching. This form will be discussed in session if it is a tool you are interesting in utilizing in your therapy.

This form is optional; however, if you utilize phone coaching services, it is a requirement.

What to do with this form
-Print
-Review it
-Ask questions, if needed
-Refer to it and complete it when needed
-Bring to next session after completing it

Adult Intake Paperwork

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About

This form is for adult clients to complete prior to the initial intake session. It gathers demographic information and personal history required to initiate therapy.

This form is a requirement.

What to do with this form
-Print
-Review it
-Ask questions, if needed
-Fill in information and sign where indicated
-Return to Thrive or bring to your initial session

ADolescent Intake Paperwork

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About

This form is for adolescent clients and their parents to complete prior to the initial intake session. It gathers demographic information and personal history required to initiate therapy.

This form is a requirement.

What to do with this form
-Print
-Review it
-Ask questions, if needed
-Fill in information and sign where indicated
-Return to Thrive or bring to your initial session

Adolescent Privacy Agreement - Under 16 Years of Age

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About

This form is for adolescent clients and their parents to complete prior to the initial intake session. It outlines what is held private between the adolescent client who is under 16 years of age and the therapist. It also outlines under what circumstances private information is shared with parents (i.e., when confidentiality is broken).

This form is a requirement for adolescent clients under the age of 16.

What to do with this form
-Print
-Review it
-Ask questions, if needed
-Fill in information and sign where indicated
-Return to Thrive or bring to your initial session

Adolescent Privacy Agreement - 16 Years of Age & Older

Download form

About

This form is for adolescent clients and their parents to complete prior to the initial intake session. It outlines what is held private between the adolescent client who is 16 years of age and over and the therapist. It also outlines under what circumstances private information is shared with parents (i.e., when confidentiality is broken).

This form is a requirement for adolescent clients who are 16 years or older.

What to do with this form
-Print
-Review it
-Ask questions, if needed
-Fill in information and sign where indicated
-Return to Thrive or bring to your initial session