🔳New Client Paperwork- for Initial Appointment 🔳

Please print and complete for you (or your childs) first session. Remember all custody paperwork is required if in place for a minor client. A legal guardian must be present as well as the minor child for the first session (for a child). And please email me or bring in a copy of the front & back of your insurance card. My Email is angie@angiesimontonlcsw.org. If the appropriate paperwork is not brought in then I may have to reschedule the appointment.

Forms for all ages

directions-to-my-office1.pdf (recommend reading as the GPS will bring you to the inaccurate location).

hipaa-1.pdf (required for all clients).

updated p& p (required for all clients).

release-of-information-a-s3.pdf (please sign one for your insurance company if it applies, an emergency contact, any medical providers, school, and anyone else you would like involved).

ace-1.pdf. (Please complete for all clients. If the client is a minor they will likely require assistance).

Forms for Minor Clients Only (under 18):

teen-assessment1.pdf (for minors only)

copy-of-sole-guardianship-form.pdf (for minors only.. to be used only in very specific circumstances).

informedconsentforminor-1.pdf (to be used for all minors, by all legal guardians, despite the marital status).

Forms for Adult Clients Only:

adult assessment 2.

adult assessment 1.