Forms
Please complete the following forms (Client Information Form - Adult and/or Child/Adolescent, whichever is appropriate, and the Release of Information Form) and either send them back to me via email at amanda.miller@seekingsunrisecounselingservices.com or you can print them, fill them out, and bring them with you to your appointment. Please note that both the HIPAA Information and the Good Faith Estimate (No Surprises Act) are both for your information and do not need to be completed.
If you have any questions or aren’t sure about something, please don’t hesitate to reach out to me. Don’t have time to fill it out ahead of your intake appointment? No worries! We can complete it when you come in.
*Any area that asks you to check something, you can put a “x” in the box or your initials. If an area asks you to circle the one that sounds most like you, you may change the font color or use the highlighter button in Word.
Thank you!
Please click on each button in order to access the form.
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Client Information Form - Adult
Please note that the form will open as a download so that you can open the document and complete it.
Please complete this form if you are an adult client.
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Client Information Form - Child/Adolescent
Please note that the form will open as a download so that you can open the document and complete it.
Please complete with your child/adolescent.
Please click on each button in order to access the form.
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HIPAA Information
Please note that this document will open in a separate window.
Note, this document is for informational purposes only and doesn’t need to be completed.
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Release of Information (ROI)
Please note that the form will open as a download so that you can open the document and complete it.
Please complete this form.
Please click on each button in order to access the form.
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Good Faith Estimate (No Surprises Act)
Please note that this document will open in a separate window.
Please note that this form is for informational purposes only and does not need to be completed.
