Balanced Life Counseling | 4305 South Lee Street, Suite 400, Buford, GA 30518

Please print and complete the following forms by clicking on your therapist.


Bring these with you to your first session. A description of each form can be found below.


*If you are coming as a couple, please print and complete an extra 'Intake Form'.


All Forms in a Single Document


Client Information Form
This form provides us with important information about the client.

    *If you are coming as a couple, please print and complete an extra 'Intake Form'.


Insurance Form
Accurate completion of this form will ensure proper billing to your insurance agency.
 
HIPAA Privacy Notice   
This form provides you with important information about your rights as a client in regards to the HIPAA Privacy Notice.


Counseling Agreement  
This form provides information about what to expect in therapy, confidentiality, and the overall operation of my services. If you have questions about this information, you may discuss them during your appointment. It is important that both adults in a couple and both parents of a child sign this form. Signing of this form indicates consent for participation in therapy and an agreement to the policies and procedures of the therapist.



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Forms

assisting you to Find balance in Your life