Forms

Please click to download the forms below.

Brent Dixon, LPC

Addendum to Informed Consent

Client intake

Credit Card Form

Disclosure and Consent

Financial Policy

HIPPA Privacy Policy

HIPPA Receipt of Privacy Practices

Renee Dixon, LSW

Addendum to Informed Consent

Client intake

Credit Card Form

Disclosure and Consent

Financial Policy

HIPPA Privacy Policy

HIPPA Receipt of Privacy Practices

Jane Dally, LPC

Addendum to Informed Consent

Consent for Child to Receive Counseling Services

Client intake

Credit Card Form

Disclosure and Consent

Financial Policy

HIPPA Privacy Policy

HIPPA Receipt of Privacy Practices