Forms

PLEASE NOTE! – If you cannot print any of the documents/forms prior to initial session, please let DaRon Stephens, LPC, LCADC, LMHC, LMT know as soon as possible. If you should arrive to initial session/consultation with no COMPLETED documents/forms, your appointment will be CANCELED. 

NEW JERSEY COUNSELING FORMS 

For your convenience, the following documents are available for you to download, print, and complete prior to your initial session. Please read, initial, and sign where stated on the document. If you have an issue printing or opening any of the documents, please contact me and I will provide the forms to you via another method.

CLIENT INFORMATION (PDF)

  ASSESSMENT (PDF)

COUPLES COUNSELING ASSESSMENT (PDF) – For Couples Counseling Only!

CLIENT RIGHTS (PDF)

COUNSELING SERVICE FEES (PDF)

DRUG & ALCOHOL SCREENING ACKNOWLEDGMENT (PDF)

NOTICE OF PRIVACY PRACTICES (PDF)

REMOTE/TELEHEALTH INFORMED CONSENT (PDF)

TREATMENT INFORMED CONSENT (PDF)

RELEASE AUTHORIZATION (PDF) – This is an optional records release document. 

Please remember to bring a valid photo ID and insurance card (if applicable) to initial session. 

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FLORIDA COUNSELING FORMS 

CLIENT INFORMATION – FLORIDA (PDF)

ASSESSMENT – FLORIDA (PDF)

COUPLES COUNSELING ASSESSMENT – FLORIDA (PDF) – For Couples Counseling Only!

CLIENT RIGHTS – FLORIDA (PDF)

COUNSELING SERVICE FEES – FLORIDA (PDF)

REMOTE/TELEHEALTH INFORMED CONSENT – FLORIDA (PDF)

NOTICE OF PRIVACY PRACTICES – FLORIDA (PDF)

TREATMENT INFORMED CONSENT – FLORIDA  (PDF)

RELEASE AUTHORIZATION – FLORIDA (PDF) – Optional

If applicable:

Please remember to provide a copy of a valid photo ID and insurance card with your paperwork upon submitting to me.

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NEW JERSEY MASSAGE & BODYWORK THERAPY FORMS

( FOR MASSAGE & BODYWORK THERAPY CLIENTS ONLY! )

Massage & Bodywork Therapy Assessment (PDF)

Massage & Bodywork Therapy Treatment Informed Consent (PDF)

All forms are Copyrighted© and belongs to:

Chat N Relax Counseling & Consultation, LLC.  

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Chat N Relax Counseling & Consultation, LLC is Registered in the U.S. Patent & Trademark Office. All content on this website, including documents, forms, & logo, is owned by Chat N Relax Counseling & Consultation, LLC. Permission must be granted by owner prior to use or referencing outside of services and/or consultation.