Lauren Penn, LCSW

Everybody needs to know their ABC's... Accept*Balance*Cope
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Forms
 
* Please download and complete the applicable forms prior to your first appointment.  Bring the completed forms with you to your intake.  If you have any questions, particularly regarding the consent form, please bring up those concerns at your appointment.   
 
** I will need to keep the signed Informed Consent in your file so please print an extra copy if you would like to keep one for your records.
 
***Please be aware that all forms were created using Microsoft Word.  If you are using other programs, especially WordPad or WordPerfect, it may cause the formatting to adjust and the forms will appear quite lengthy.  I apologize for any inconvenience (or ridiculous waste of paper!) that this may cause you.
 
Forms for Adults (Please make sure you have all of those that apply to you.  You will need to click on each one individually.)
 

1.  /Documents/Adult Contact Info.doc

2.  /Documents/Client Intake.doc

3.  /Documents/Informed Consent.doc

4.  /Documents/Insurance ROI.doc (this includes EAP) 

5.  /Documents/Credit Card Auth.doc (OPTIONAL, if you would like to keep a credit card on file for convenient ongoing billing)

 

*** If you are coming for couples counseling, please download 2 copies of the Client Intake form, 1 for each partner.  Both partners should also sign the Informed Consent.

 

Forms for Children/Teens (Please make sure you have all of those that apply to you/your child.  You will need to click on each one individually.)

 

1.  /Documents/Child-Adolescent Contact Info.doc

2.  /Documents/Client Intake.doc

3.  /Documents/Informed Consent.doc

4. /Documents/Insurance ROI.doc  (this includes EAP) 

5. /Documents/Credit Card Auth.doc (OPTIONAL, if you would like to keep a credit card on file for convenient ongoing billing)

 

*** Please note that if your child is 14 years old or older, both you and your child need to sign the informed consent for treatment. 

 

If you would like to see my detailed Notice of Privacy Practices (HIPPA), please download the form below.  This form is for your information only. 

1.  /Documents/HIPPA.doc