I would like to take this opportunity to thank you for choosing Austin Wellness, PLLC for your care.
In order to provide counseling services the forms below are needed for the purpose of evaluating, diagnosing, and treating each client. Please print, read, and fully complete the necessary forms and bring all forms the first appointment.
A copy of your driver’s license will be needed in order to validate your identity.
Client Intake Forms:
- Minor Intake Form (updated April 9, 2020)
- Adult Intake Form (updated April 9, 2020)
Additional necessary forms of consent and disclosure:
- Consent for Treatment and Psychotherapy Services and Policies (updated Nov. 22, 2021)
- Consent to Communicate via Electronic Devices Social Media and Internet Policy (updated April 9, 2020)
- EMDR Acknowledgement & Consent Form (updated April 9, 2020)
- Consent and Authorization of Disclosure of Protected Health Information (PHI) (updated April 9, 2020)
Cancellation
If you are unable to keep an appointment, you are kindly asked to provide at least 24 hours’ notice. This advance notice will allow appointments to be offered to other clients. A fee will be charged if the client does not show up for an appointment.