Forms

Welcome to Womencare

Please click on the links below to access the necessary forms for your first visit.  Please print, complete the forms, and bring them in with you to your first session.

We look forward to working with you.


Counseling Forms

1. Welcome / Who We Are

2. Client Information Form (Download)*

3. Counseling Agreement Form

4. Notice of Privacy Practices

5. Receipt of Privacy Practice Notice

6. Consent for Telehealth Consultation

7. Debit/Credit Card Authorization Form (Download)*

8. Safe Harbor Agreement


Additional Forms

1. Release of Information (Download)*

2. Group Counseling Agreement

3. Professional Consultation Agreement

 

*Download forms are enabled so that you can type your responses directly on the forms to email back or print out to bring to your session.