Bayou Wellness Forms:
Authorization For Disclosure (In Couples or Family Therapy)
~A NOTE from Andrea~
Congratulations on taking the step into therapy! While counseling can be rich with rewards, there are certainly some risks involved, such as allowing yourself to become vulnerable, experiencing a heightened sense of anxiety before symptoms get better, and even being faced with uncomfortable changes you may have to make to better your situation. Remember, your wellness and mental health are the top priorities of counseling. To ensure this experience in the most professional, ethical, and effective manner, please take time prior to your first visit to print and fill out the appropriate forms. Bring them with you to your intake session, or you may scan and email the signed/completed forms to me at firstname.lastname@example.org. If printing is an issue for you, forms will be provided for you upon your arrival. New clients must attend 20 minutes early to the first session to fill out forms. Any questions you have about the forms will be happily addressed in session.
Which forms do I complete?
All clients must complete the New Client Intake Form. Adults seeking individual, couples, or family therapy must complete the Informed Consent To Therapy - Adult form. Both/all parties within a couple/family may sign the same form. Adolescents seeking individual therapy must complete the Informed Consent And Confidentiality Agreement - Adolescent form.
Mental Health / Substance Abuse / Anger Management Assessment
If you are seeking a mental health, substance abuse, and/or anger management assessment, please fill out the Bio-Psycho-Social-Spiritual Assessment packet. Again, if printing is an issue for you, this packet will be provided to you upon arrival to your session. However, due to its length, new clients must attend at least 45 minutes prior to their scheduled appointment in order to complete the packet in its entirety. You will notice that there are many personal questions on the assessment that address aspects of your life for which you may not be attending counseling. The answers to all of the questions guide me in drawing a whole clinical picture which helps me to formulate the best possible hypothesis that will help you in your treatment. Take heart in knowing that I do my very best to create a safe place for you to feel complete freedom to share what you need to share. There is no judgement here. Just help. The more forthcoming and honest you can be, the better the results of the therapy you will receive.
If you are requesting that another health care provider, such as your doctor or another therapist, provide me with your medical or mental health records, please fill out and sign the Authorization For Release of Protected Health Information, indicating the type of records you would like released or obtained and where you would like them sent.
Clients entering family or couples therapy or who are interested in having me discuss private information with another party (i.e. mom, dad, significant other) for the purpose of your well-being and treatment will need to complete the Authorization For Disclosure. This form is different from the Authorization For Release of Protected Health Information because I will not actually be providing the other party with your clinical records but rather discussing information relevant to treatment.
I am so glad you have chosen Bayou Wellness to serve you. Now, let's get started.