Forms
The following forms are provided for your convenience via DocHub. The information you provide will be kept confidential, however, even in using a secure platform VCFR cannot guarantee complete confidentiality and there is a risk of access by unauthorized persons. Please see DocHub’s Privacy Policy for more information. https://dochub.com/site/privacy
A word of caution; failure to utilize a secure email platform could result in your personal information being accessed by unauthorized persons. Once you have completed these forms, we encourage you to print your paperwork for your records and opt to NOT receive an emailed copy in an effort to reduce the risk of your personal information being compromised.
Completion of forms is required prior to your first appointment. The forms will help your counselor better understand the challenges you are facing and assist in developing an effective treatment plan. (There are some exceptions to confidentiality. Please read "Things No One Tells You About Professional Counseling").
If you would prefer, we can mail you these forms. Please discuss any questions/concerns with the office administrative staff.
Before You Begin
Instructions for completing forms:
PLEASE NOTE** You will be asked to sign in using your personal email address/password, and create a free account on DocHub.
It is important for everyone to read these 2 documents.
This is basic information for you to understand regarding the counseling services VCFR provides. It includes; the routine office guidelines and procedures, explains how the insurance companies determine if they will pay for the counseling, and includes some cautions regarding the use of insurance.
More to read: As required of all medical practices, our federal government wants you to be made aware of our HIPAA policies: HIPAA Privacy Notice
Telehealth Adult Paperwork Form
Please select this paperwork if you and/or your child are above the age of 15.
Telehealth Child Paperwork Form
Please select this form for a child under the age of 15.
Please select this form if you will be NOT be using insurance for your visits. This form should be used for individuals.
If you are coming in for couples or marriage therapy, complete two forms - one for each spouse/partners.
Please read: Does Insurance Cover Marriage Counseling or Couples Counseling?
If you choose to use health insurance, most insurance companies require a coordination of care with your Primary Care Physician. Please complete this form with your PCP's complete address and bring it in for your initial visit.
Please complete the form below if you wish to allow the exchange of your information with relevant care givers or other appropriate entities.
Please complete the form below if you are a Pastor and would like to participate in the confidential Pastoral Support Group.