{"id":48,"date":"2016-05-22T13:31:40","date_gmt":"2016-05-22T19:31:40","guid":{"rendered":"http:\/\/www.emilylutringer.com\/therapy\/?page_id=48"},"modified":"2016-05-22T13:34:06","modified_gmt":"2016-05-22T19:34:06","slug":"forms","status":"publish","type":"page","link":"https:\/\/www.emilylutringer.com\/therapy\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"

IntakeHIPPASignature<\/a>\u00a0\u2013 This document has several spots that you need to initial. \u00a0It is your agreement that you understand your rights and responsibilities.<\/p>\n

Rights and responsibilities HIPPA<\/a>\u00a0\u2013 There is nothing you need to fill out in this document, but please read it, it describes your rights and responsibilities for counseling.<\/p>\n

ROI<\/a>\u00a0\u2013 please print one copy for each person you want the counselor to be able to contact\/speak with. \u00a0Usually, one for your Doctor (PCP), one for your child\u2019s school, and one for anyone else we might need to communicate with.<\/p>\n

Treatment Plan SIGNATURE SHEET.pdf<\/a>\u00a0\u2013 This document gives your permission for us to create a treatment plan for you or your child.<\/p>\n

\u00a0<\/p>\n

ADULTS<\/strong><\/p>\n

Adult_intake_form<\/a>\u00a0\u2013 This form helps us to understand what issues you are dealing with, and other important information that will help us formulate the best course of treatment.<\/p>\n

AdultContactInfo<\/a>\u00a0\u2013 \u00a0This contains your contact information<\/p>\n

\u00a0<\/p>\n

CHILDREN \/ ADOLESCENTS<\/strong><\/p>\n

Child Outcomes questionaire<\/a>\u00a0\u2013 This is a useful questionnaire to be completed by a parent or guardian, or the child themselves if they are old enough. \u00a0It can also be helpful to have your child\u2019s teacher complete one. \u00a0We will complete one of these at the start of counseling, and complete it again roughly once per month to help identify if treatment is working and areas we need to focus on.<\/p>\n

ChildAdol_Intake_form<\/a>\u00a0\u2013 This form helps us understand what issues your child is dealing with, and other important information that will help us formulate the best course of treatment<\/p>\n

ChildAdolContactInfo<\/a>\u00a0\u2013\u00a0This contains your child\u2019s contact information<\/p>\n

\u00a0<\/p>\n<\/body>","protected":false},"excerpt":{"rendered":"

Please print and complete, to the best of your ability, the following forms prior to your first appointment. \u00a0Be sure to bring them with you, or email completed documents to ELutringer@gmail.com. ALL CLIENTS IntakeHIPPASignature\u00a0\u2013 This document has several spots that you need to initial. \u00a0It is your agreement that you understand your rights and responsibilities. … <\/p>\n