Client Forms

Margaret Neal, LCSW | Riverside, CA
 

Some of these forms will be needed for your first therapy session. Fill out only the forms that I indicated that you would need. Please bring the completed forms to your first session.

 

FORMS FOR A CHILD CLIENT

  1. Acknowledgement of Receipt of Privacy Practices
  2. Child Info Sheet
  3. Insurance Claim Form (print page 1 only)
  4. Child Medical History
  5. General Consent for the Treatment of a Minor
  6. Informed Consent
  7. Limitations of Confidentiality in Couple and Family Therapy
  8. Notice of Privacy Practices (HIPAA)

FORMS FOR AN ADULT CLIENT

  1. Acknowledgement of Receipt of Privacy Practices
  2. Adult Info Sheet
  3. Insurance Claim Form (print page 1 only)
  4. Adult Medical History
  5. Informed Consent
  6. Limitations of Confidentiality in Couple and Family Therapy
  7. Notice of Privacy Practices (HIPAA)


Margaret W. Neal, LCSW
3400 Central Ave Suite 310
Riverside, CA 92506
Telephone: 951-275-5200
Contact


CA License #LCS9622