Christina M. Schultz, MA
Resident in Counseling
Supervised by Thomas F. Lamp, LPC
New Directions Counseling Group, LLC

INTAKE FORM

INFORMED CONSENT

This intake form includes the intake information I need prior to your first session.  
This form includes the Notice of Privacy Practices, including limitations of confidentiality, your client rights and responsibilities, and my cancellation policy.  I will review this form before our first session/group, but I need your signature for this form before we can begin counseling.

MEDICAL RELEASE FORM

COUPLES THERAPY 
GUIDELINES & EXPECTATIONS

This form is needed to release medical information, including confirmation that you are my client, to enable communication (by phone and/or letter) to your health provider or another entity.
This form consists of Gottman couples therapy guidelines and expectations to start  your couples therapy.

HIPAA FORM

This form is needed to comply with federal law governing the protection of your protected health information (PHI).  
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires me to protect the privacy of your PHI and to give you this notice.