Paperwork

Hello there! I am excited to meet you and to help you get on the path of connecting better!

Please set aside about 30-45 minutes to read and complete the required paperwork. If you have any issues printing any of this, please contact me and I will have it printed up for you (if you are being seen within normal business hours/building hours (M-F 9am – 5 pm) I will leave the packet(s) with the receptionist (Helen) and you will need to come in 30-45 minutes prior to your appointment to complete it – if you are being seen after hours or on Saturday, you will need to arrange to pick it up during business hours prior to time of your session or if time allows you can request that I mail it to you.

Paperwork can be also gotten in the portal (ask me how if I did not tell you in our first call) and sent back as an attachment through the portal under messages. You can log in to fill out your contact information (please ignore the questions about insurance as they do not apply) and see it’s other convenient features/benefits.

If you’d rather, you may mail the paperwork ahead of time or bring the paperwork with you to the first meeting along with a form of payment and legal identification.

*Each member of the family will complete their own intake packet. If you are an adult – please fill out the Adult Intake Packet. Please have children fill out the Child Intake Packet.

*Each family will need to print out 1 Signature Packet as multiple people can sign the same document. All participants will need to read, understand, and commit to these documents in order to become clients of Better Together Counseling. By signing the signature pages – you are legally accountable to these consents, policies and practices.

*If you have a child(ren) who will be participating in sessions, all custodial parents/guardians must approve by filling out the Non-Intact Family Waiver. If there is no other custodial parent/guardian due to a legal agreement – the therapist will need to make a copy of the legal document that states that you are the sole custodial parent/guardian that makes healthcare decisions for the child.

*If you or anyone participating in therapy would like for me to speak with anyone on your behalf (e.g. your individual therapist), please fill out the Authorization to Release/Exchange Information Form.

I look forward to meeting you soon!

Adult Intake Form
Each participating adult will need to download, print, and complete a separate Intake Form.
BT intake packet for website.pdf
Adobe Acrobat document [634.0 KB]

Download Form

 

Child Intake Form
Each participating minor will need to download, print, and complete a separate Intake Form.
BT Child Intake Packet.pdf
Adobe Acrobat document [402.7 KB]

Download Form

 

Signature Packet
Each couple/family will need to download, print, read, understand, agree to, and sign these documents. Only one document per family needs to be printed as there is room for multiple signatures.
09.15.22 BT ICFT, NS, and HIPAA NPP
Adobe Acrobat document [144.6 KB]

Download Form

 

Non-Intact Family Authorization for Services
For family’s in which there is more than one person with legal custody/guardianship – this document will need to be signed by the non-participating/non-therapy seeking legal guardian.
BT non-intact family agreement.pdf
Adobe Acrobat document [578.2 KB]

Download Form

 

Authorization to Release of Exchange Information
This form is used when a client wishes for EH to speak with someone on their behalf. Each person that partakes in therapy will need to give consent/sign to share information due to F.S. 491.0147(2).
BT auth for release exchange info.pdf
Adobe Acrobat document [523.7 KB]

Download Form

Authorization to record sessions

This form is used when a couple/client authorizes EH to record a session for the purposes of EH doing a self review to better her craft, of EH gaining professional supervision to better her craft, and/or of EH seeking certification (e.g. for Emotionally Focused Therapy).

EFT Recording Release Form

Download Form