Forms

Professional Disclosure Statement and Informed Consent: Lauren Jones

This form is required for all new clients of Lauren Jones.
Please complete this form prior to your first scheduled appointment.

Adult Client Intake Form

This form is required for all new adult clients.
Please complete this form prior to your first scheduled appointment.

Child & Adolescent Client Intake Form

This form is required for all new child and adolescent clients.
Parents and guardians: please complete this form prior to your child’s first scheduled appointment.

Consent for Transmission of Protected Health Information by Non-Secure Means

This form is required for all new clients.
Please complete this form prior to your first scheduled appointment.

Online & Phone Counseling Release Form

This form is required for all new clients participating in online or phone sessions.
Please complete this form prior to your first scheduled appointment.

Consent for Release of Information Form

This form is required to give consent for Neema Counseling to release information to a third party (e.g. billing, coordinating care, verification letters, etc.)
Please complete this form if needed.