Please read and follow ALL of these directions carefully for your Coaching, Counseling or Hypnotherapy First Session (Intake Session).
As a new Counseling or Hypnotherapy Client, please complete the required forms below, make copies for yourself and bring them to your Intake Session.
Coaching clients will need to download, complete and get ONLY the Intake Form to me.
Please Note: My fees are listed in the Disclosure Statement below.
First Session of Coaching, Counseling or Hypnotherapy
You may go to My Appointment Calendar to schedule your Intake Session appointment and make your payment online securely and safely through PayPal. You do not need a PayPal account. You can login as a guest.
If you are a Counseling or Hypnotherapy client in my Colorado practice and want to submit your counseling charges to your insurance company for reimbursement, please let me know in your First Session of Counseling or Hypnotherapy, in which case I will provide monthly statements to you ready for your insurance company if you qualify for a diagnosis.
All coaching sessions will not qualify for insurance reimbursement and no diagnosis will be given. This applies to all coaching video-conferencing sessions or phone sessions anywhere in the U.S. outside the state of Colorado.
Helpful Suggestion: Keeping a journal during your therapy can be very beneficial for several reasons. At the beginning of therapy you may want to define your goals and write them in your journal.
Please note: My work includes my therapy dog, Sadie who is a little Pomeranian. She will be at my office during some or all of your visits with me to assist in your healing when appropriate. She will greet you when you arrive and say goodbye before you leave. If you have an allergy to dogs please let me know in advance, so I can plan ahead for your appointments.
Bringing your journal to your sessions allows you to jot down important points you’ll want to remember from your sessions and begin applying to your life to make the changes you desire. Lastly, recording the steps you are taking daily to move toward your goals keeps you focused on your success instead of the pain you’re experiencing.
PLEASE NOTE: First Session of Counseling or Hypnotherapy. You will only need to bring the Client Intake Form, Disclosure Statement & HIPAA Privacy Policies listed directly below, unless you wish for me to consult with another health care provider, relative or friend, in which case you are required to also bring the Authorization to Release Information Form. After filling out these forms please make copies of them for your records prior to bringing them to your first session.
VERY IMPORTANT – PLEASE NOTE: These forms are necessary for me to complete your Intake & Assessment. If you don’t have them at the first session, you will need to fill them out during your first session at my office. It takes approximately 30 – 40 minutes to read and complete them, so please be prepared and not have to use your session for this purpose. If you’ve scheduled an Intake Appointment at my office, please arrive prepared with these forms below completed for your First Session. If your first session is by phone or online video conferencing with me, I will need these forms scanned and emailed to me or you may mail them to my office.
If you’ve schedule with me at my office, please make yourself comfortable in the waiting area outside my office, and I will come to you when I am ready to begin your session with me. I look forward to our time together!
- Client Intake Form
- Disclosure Statement
- HIPAA Privacy Policies
- Authorization to Release Information
Please click on the appropriate links to download the forms below:
|Client Intake Form L-Revised|
|HIPPA__ L – Revised|
Note: To download Adobe Acrobat Reader for free, click here.
Avelon B McNae