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Client Forms

New client intake packet All new client intake paperwork must be completed and submitted before your first session. Please ensure that all required fields are completed and that all necessary signatures are included. Your first session may need to be rescheduled if the paperwork is incomplete or unsigned. These forms provide your counselor with important information about your background, current concerns, treatment goals, and relevant medical and mental health history. Completing the paperwork in advance allows your counselor to better understand your needs and make the most of your initial session. All information is kept private and confidential in accordance with applicable laws and professional standards. Please answer each question as thoroughly and honestly as possible. If you have questions or need assistance completing the forms, please contact your counselor. Release of Information The Release of Information Form allows you to authorize Sound Mind Counseling and your counselor to communicate with specific individuals, healthcare providers, schools, attorneys, or other organizations involved in your care. You may identify what information can be shared, with whom it may be shared, and the purpose of the communication. Please complete all required fields and include all necessary signatures before submitting the form. Your information will not be released without your written authorization, except when disclosure is required or otherwise permitted by law. Credit Card Authorization The Credit Card Authorization Form allows Sound Mind Counseling to securely maintain a payment method on file for services provided. The authorized card may be used for session fees, copayments, deductibles, late cancellations, missed appointments, or other balances owed in accordance with the practice’s financial policies.
Please complete all required fields and include the cardholder’s signature before submitting the form. By signing, the cardholder authorizes Sound Mind Counseling to charge the card for applicable fees and acknowledges responsibility for any outstanding balance.
727-647-1546
nkcounseling@hotmail.com
Location
3060 Alt. 19 N. Suite B17, Palm Harbor, FL 34683
Mon - Fri: 6:00 a.m. to 10:00 p.m. Weekend and after-hour sessions available upon request. Hours vary per clinician
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