New Client Forms

 
 

Please print and complete the relevant paperwork below to bring to your first appointment. Please fill out as much as you can, and I will work with you to address any questions or concerns you may have. If you are unable to bring your paperwork with you, please arrive 20-30 minutes prior to your appointment, and I will be happy to provide copies for you to fill out in our office.

 
 
 

 
 
 

REGISTRATION FORM

The Registration Form requests consultation and treatment by Elizabeth Miller, LISW, LLC.

HEALTH HISTORY FORM

Prior to our appointment, please complete this form for the person who will be receiving services.

ELECTRONIC COMMUNICATION CONSENT FORM

This form pertains to the exchanging of information via electronic technology.

HIPAA NOTICE FORM

This Notice Form is required by HIPAA (Health Insurance Portability and Accountability Act) Regulations

OFFICE POLICIES FORM

This office policies form contains important information about confidentiality, fees and insurance.

 
 

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