Heal Together Counseling

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    • Services
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    • Therapy Pre-Screener
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    • Special Ed Advocacy Forms
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  • More
    • Home
    • About Me
    • Services
      • Services
      • Fee Schedule
      • Insurance Reimbursement
    • Forms
      • Therapy Pre-Screener
      • Therapy Forms
      • Parent Coaching Forms
      • Special Ed Advocacy Forms
    • Resources
    • Contact HTC

Heal Together Counseling

Heal Together CounselingHeal Together CounselingHeal Together Counseling
  • Home
  • About Me
  • Services
    • Services
    • Fee Schedule
    • Insurance Reimbursement
  • Forms
    • Therapy Pre-Screener
    • Therapy Forms
    • Parent Coaching Forms
    • Special Ed Advocacy Forms
  • Resources
  • Contact HTC

Therapy Forms

These forms should only be completed & submitted at the request of the provider.

HTC Consent to Treatment 2024 (pdf)Download
HTC Financial Agreement 2024 (pdf)Download
HTC Good Faith Estimate 2024 (pdf)Download
HTC Insurance Opt Out Form 2024 (pdf)Download
HTC Intake Form 2024 (pdf)Download
HTC Privacy Practices 2024 (pdf)Download
HTC Release of Information 2024 (pdf)Download
HTC Telehealth Consent 2024 (pdf)Download
HTC Walk & Talk Consent 2024 (pdf)Download

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