Patient Care Services  > Palmetto Health Counseling  > Forms 

Forms

Palmetto Health Counseling

Once you have scheduled an appointment with us, you may download forms to complete at home and bring with you to your first appointment. The forms that are needed at the first appointment are:

  1. A separate Adult Intake Form for each person attending the session (Youth Intakes are for clients under 18),
  2. A signed Fee Agreement Form indicating your preferred method of payment. If you are using insurance or an EAP, you will need the Insurance Information Form.
  3. A signed Informed Consent Signature Form (Read the What You Should Know About Counseling Form and the What You Should Know About Your Counselor Form.),
  4. A signed Acknowledgement of Notice of Privacy Practices Form. Don't forget to download and read the accompanying Notice of Privacy Practices Form.
  5. The Coordination of Care Form must be filled out and signed even if you choose the option not to allow coordination with your family or referring doctor.

Adult Intake Form

Coordination of Care Permission Form

Fee Agreement Form

Things You Should Know About Counseling Form

Informed Consent Signature Form

Insurance Information Form

Notice of Privacy Practices Form

Acknowledgement of Notice of Privacy Practices Form

Youth Intake Form 


Professional Disclosure Forms by Counselor Name

What You Should Know About Louise Duval

What You Should Know About Danny Garnett

What You Should Know About Angie Hall

What You Should Know About Jan McMeekin

What You Should Know About Debra Moore

What You Should Know About Mark Stoll

What You Should Know About Lisa Williams