Forms

Below are all the forms needed to begin treatment.  The forms are able to be downloaded and filled out (electronically if you choose).  All appropriate forms must be signed, initialed, dated and returned before services can begin.  If you’d like, you may email them to chris@fourbodiestherapy.com with the heading “Signed Forms” or return them to me in person at our first visit.

Adult clients (over 18 years) and parents of minors:

  • All clients should fill out both a Client Questionnaire  and the Informed Consent Service Contract.
  • Clients who would like to do Telemedicine (Skpye, phone, etc.) should fill out the Telemedicine form.
  • Clients who would like my collaboration with their other healthcare professionals should fill out a Release and Exchange.

Minor clients (14-17 years age) seeking treatment on their own:

  • All clients should fill out both a Client Questionnaire  and Minor Informed Consent Service Contract.
  • Clients who would like me to speak with their other healthcare professionals should fill out a Release and Exchange.

*If you have any questions about the forms, please email me “Form Question” at info@fourbodiestherapy.com

Client Questionaire

This client questionnaire helps me to get to know you better.  Each client should fill out this form to the extent that they feel comfortable.  Form should be returned before or on the first visit.  Thank You!
Download (PDF)

Informed Consent Service Contract

This form is for all adult clients (over 18 years of age) and parents supporting teens.  Each client must read, initial, sign and return this form before or on the first visit.  Thank You!
Download PDF

Minor Informed Consent Service Contract

This form is for all minor clients (14-17 years of age) seeking treatment on their own.  Each client must read, initial, sign and return this form before or on the first visit. I am happy to answer any questions you may have.  Thank You!
Download PDF

Telemedicine Form

This form is for all adult clients (over 18 years of age) who wish to have sessions via Telemedicine (Skype, phone, etc.)   Each client must read, sign and return this form before the first session.  Thank You!
Download PDF

Release and Exchange

This form is for all clients who wish for me to collaborate with their other healthcare professionals or with third-parties.  Each client must read, sign and return this form before any confidential information may be shared.  Thank You!
Download PDF