Additional Forms
Instructions:
Click on the links below to print the forms you need. Complete the forms and bring them to your first counseling session.
Click on the links below to print the forms you need. Complete the forms and bring them to your first counseling session.
- Pre-payment Option - To be completed if you wish to utilize the cash prepayment option for counseling.
- Consent to Release Information - Gives consent for Dr. Belaire to interview and get records from third party individuals or organizations.
- Release to Record Sessions – Occasionally Dr. Belaire may record a session in order to take notes at a later time or to monitor progress. Recorded sessions are protected under HIPAA and are deleted after use.
- American Counseling Association (ACA) code of ethics - Professional code of ethics for your review as needed
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