Print forms
- Adult Registration Packet
- Child Registration Packet
- Adult ADHD Evaluation Registration Packet
- Credit Card Authorization form
- Release of Information form
Privacy statement
General instructions
Save yourself time, effort and frustration by bringing all completed forms to your first visit. You must complete them in the waiting room prior to your visit if you forget. If you print out the forms at home, but don’t have time to complete them please come to your appointment 15 minutes early to finish filling them out.
Each packet includes a confirmation that you have read my Notice of Privacy Practices for Patricia Lee, LLC. The statement is not included in the packet, but can be read online or printed for your information here
If you and your partner are coming for marital/relationship counseling each must complete his/her own packet. If your family is coming for counseling, each person over the age of 18 must complete an adult packet and under 18 a child packet. To shorten the paperwork, you may complete only the “self” column of the history form for each child. Family information that is the same for each child does not need to be completed on each separate child registration page.
If you are completing the packet for your child keep in mind that the first column on the family history form “self” refers to the child, not the person completing the forms.
If you are uncertain about information on the Fee Agreement or Your Rights As a Client statement you may sign after I answer your questions at our first appointment.
All questions on the drug and alcohol screen should be circled either yes or no.
