Paperwork

 

Before we meet for the first time there are some forms to be read and/or printed and completed before or by the first session.  I prefer that you send me the paperwork 48 hours in advance of our scheduled session (scanned and emailed to nichole@nicholelorenz.com).  If you can do so, please text me at 734-604-0654 to verify that you have scanned and sent the paperwork, AND still bring the hard copies to the office for your first visit.

 

There are 6 forms in all to get started: 

 

1) Overview of Clinical Practice (4 pages)

2) Social Media Policy (4 pages)

3) HIPPA (7 pages)

4) Initial Consultation Form (2 pages)

5) Digital Communications (1 page)

6) Insurance Information for Billing Purposes (1 page) 

If you are receiving bodywork/energy work please fill out this form as well

 

 

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Please simply read through the following 3 forms:  

 

1) Social Media Policy

2) Overview of Clinical Practice

3) HIPPA 

 

Please print out the following 4 forms in order to fill them out and bring them to your first session. If you are the parent or legal guardian of a child/adolescent please fill out the 1) child/adolescent initial consult form, 2) child/adolescent consent for treatment form, 3) last page of the HIPPA form, 4) Digital communication form and 5) insurance information for billing purposes (if you are billing your insurance company for sessions).

1) Last page of the HIPAA form (1 page)

2) Initial Consultation Form (2 pages)

3) Digital Communication (1 page)

4) Insurance Information for Billing Purposes (1 page)

 

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If you have completed the initial consult with Nichole and decided that you would like to continue ongoing psychotherapy services with her, please fill out this form. 

 

Ongoing Adult Intake Form

Thanks for going through this paperwork - it will probably take about 20-30 minutes in total.  

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