One Step At A Time
Therapy for Individuals, Couples and Families

Respecting The Journey

Cindi Rieb, MA, LPC

257 Johnstown Center Drive, Suite 208

Johnstown, CO 80534

970-587-4963

 

 

FORMS:

If you are a new client, please complete the following forms and bring them to your first therapy session:

Client Rights - This form supplies information regarding the regulation of psychotherapy and guidelines of service which includes information about services provided; client's right to a second opinion; fee and payment policy;and cancellation policy.

Health and Insurance Portability and Accountability Act (HIPAA) - This form is the same form that you would receive from doctors, dentists, pharmacists and any other healthcare provider. It describes how medical information about clients may be used and disclosed.

Adult Client Intake Form - This form addresses general client information in addition to questions about mental and physical health, family background and general history information.

Minor Child Intake Form - This form is specific to information regarding a child such as parents' names and consent to child treatment.

Family and Couples Client Intake Form - This form is specific to information regarding family and couples and reasons seeking family counseling.

Couple Admission Intake Form - This form addresses general client information for couples in addition to questions about mental and physical health, family background and general history information.



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