Forms

FORMS FOR ADULTS

New adult clients need to download and complete all of the asterisked forms:

*ICS Business Policies Procedures

*Adult Initial Meeting Information

*Consent to Treatment

*ICS Privacy Policies and Client Rights

*ICS Social Media Policy

 

FORMS FOR CHILDREN

Please select the age appropriate initial meeting form for your child and substitute it in for the adult one above so that all the other forms plus the form fitting your child’s age are completed. 

If your child is old enough to complete the personal questions on this form him/herself please ask her/him to do so and allow her/him the privacy to fill it out confidentially. I am happy to discuss this with you (the parents) in our initial phone consultations so that you understand the reasoning behind this. You will need to sign all the other legal forms for consent if your child is a minor but s/he will be better served if s/he has an opportunity to share her/his personal feelings/needs privately.  Feel free to provide your child with an envelope.  We will discuss together the types of information that I cannot keep private when it comes to safety.  Thanks so much.  Having these forms ahead of time will save us about 20 minutes at your first appointment but I can provide them if you do not have access to  a printer. Please let me know.  

Respectully, Miriam

School Age Child Initial Meeting Information

Teenager Initial Meeting Information

ICS Child Psychosocial Assessment

 

 

 

 

Professional Disclosure Statement for Clinical Supervision (PDF)