Forms

Forms 2017-09-19T16:56:37+00:00

If you’re a new client, please complete the following forms and eSign and/or bring them to your first therapy session. For your information, all eSign documents will be automatically emailed to Aspire.

Six required forms:

1. Consent for Services

2. Client Information

3. Notice of Privacy Practices

*Please read this Notice; however, it is not necessary to print unless you would like a copy for your own records.

4. Receipt of Notice

5. Credit Card Payment Authorization

6. Electronic Communication Consent

Optional form: If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of Protected Health Information (“PHI”)

Authorization for Release of Information

For other providers making referrals to Aspire:

Referral Form