Forms

The buttons below will take you to our online forms that will be processed through our secure, HIPPA approved servers and sent directly to Jeff Nelson, LSCW.

Treatment Exclusions Form

Telemental Health Informed Consent

Surprise/Balance Billing Disclosure

Release of Information

Informed Consent

HIPAA Form Privacy Practices

Consent to Treatment and Recipient's Rights

COVID-19 Waiver Form

Client Information Form

Client Admission Form

Disclosure, Treatment & Fee Agreement Form

Pychotherapy Services

grief + loss therapy | mood disorder therapy | self-esteem issues | substance abuse | gay + lesbian
physical and sexual abuse survivors | cognitive behavioral therapy

Tel 303.408.9658 | Contact