The “Personal Information Form for Children” provides us with basic background information that will help us get to know them better. Download and complete this form if you are the parent or guardian of a minor client (under age 18) prior to your first visit with their therapist. If you are unclear as to how to complete any part of this form, please bring it to your first appointment and discuss it with the therapist.
The “Personal Information Form for Adults” provides us with basic background information about you that will help us to get to know you better. Download and complete this form if you are scheduled to see a therapist for the first time at MAPS, prior to your first visit with your therapist. If you are unclear as to how to complete any part of this form, please bring it to your first appointment and discuss it with the therapist.
The MAPS Signature Page gives us your consent to bill your insurance for the services we provide. This form also asks for your signature to confirm that you have received and read our “Professional Disclosure Statement” and our “Notice of Privacy Practices”. Please note that you are asked to sign in three places prior to commencing psychotherapy.
The MAPS Professional Disclosure Form is a summary of important policies and procedures for MAPS Counseling Services. Here you most frequent questions are answered, as well as questions about confidentiality, emergency service, and other questions that you may have now or later.
The Notice of Privacy Practices is a State and Federal mandated form that tells you your rights about the use and disclosure of your medical information under the Health Insurance Portability and Accountability Act (HIPAA).
The MAPS Authorization to Disclose or Obtain Confidential Information (Release Form) is required whenever you or your therapist would like to share information or communicate with anyone else about the services you are receiving.