Intake Forms
Below please find our intake forms for new clients. Please complete prior to your first appointment with your practitioner.
Forms for Clients
This form outlines Ivy Counseling Groups office policies and procedures. All clients must review and complete this form.
This form collects contact, billing, and insurance information. We also ask for information regarding your reason for utilizing our services. All clients must complete this form.
This form should be completed by all clients after review of the Notice of Privacy Practices Sheet.
All clients should review this sheet and then sign the above Notice of Privacy Practices form.
All clients meeting with Alla Rosina or receiving energy medicine treatment should complete this form and bring it to their first appointment.
This form should be completed by clients who wish to have their practitioner consult outside services, including primary physician, referring practitioner, education professionals, etc. Completing this form is not necessary for all clients and is based solely on client need.