Grit to Grow Therapy

Please complete the Client Intake Packet below prior to your first appointment.

What does the Client Intake Packet include?

• Informed Consent Form: Outlines the treatment process, risks, benefits, credentials, and client rights. It also details critical limits to confidentiality.
• Notice of Privacy Practices (HIPAA): A federal requirement explaining how a client’s protected health information is used, shared, and guarded, accompanied by a signed acknowledgment of receipt. 
• Good Faith Estimate (No Surprises Act): A required federal form given to uninsured or self-pay clients detailing the expected costs of care. 
• Telehealth Consent Form: Required if any part of therapy occurs online or over the phone, explaining the risks and security of virtual sessions. 
• Financial and Payment Policies: Outlines fees, insurance billing practices, cancellation windows, and late-fee structures.
• Client Information / Demographics: Gathers basic contact details, date of birth, and emergency contacts.
• Release of Information (ROI): A voluntary authorization form used only if the clinician needs to coordinate care with outside providers, psychiatrists, or family members.
• Intake Questionnaire: Gathers background history, current symptoms, and previous medical or mental health history.