If you did not have your evaluation done by Choice Counseling Center, please fill out all the following forms. If you did have your evaluation completed by Choice Counseling Center, you do not need to fill out the first three forms (Personal History Form, HIPPA, and Consent for the Release of Information) as you have already filled out these forms when you did your evaluation. However, you will need to complete the other forms on this page.
HIPPA Notice of Privacy Practices: This form explains your rights & responsibilities as a client, as well as explains the limits of confidentiality. You must complete this form stating that you have read and understood.
Consent for the Release of Information: Please complete this form and provide us with your probation officer’s information. If you are not on probation, please provide us with the contact information of whomever referred you: i.e. attorney, pre-trial officer, employer, employee assistance program, military, etc. If you do not provide us with a signed consent form, we cannot send your referral source an evaluation or even communicate with them that you came to us. If you would like your evaluation sent to multiple sources, please complete this form multiple times, once for each source.
Treatment Plan – Short-term – please only complete this form if you were given six to twelve weeks of treatment at your evaluation. If you received long-term treatment of seventeen to fifty two weeks, please skip this form and complete the next form.
Treatment Plan – Long-term – please only complete this form if you were given seventeen to fifty two weeks of treatment at your evaluation. If you received short-term treatment of six to twelve weeks, please skip this form and complete the previous form above labeled “short-term”.
Please complete the following treatment enrollment form stating that you are selecting Choice Counseling Center as your treatment provider.
Below are the group rules for attending all Choice Counseling Center group counseling sessions. Please sign that you have read and understood the rules.
Thank you for completing all the forms. You are now registered for groups. Now you can download the ZOOM app from the app store on your phone or you can familiarize yourself with the zoom.us website. All of our groups are held virtually on zoom for the time being during the COVID pandemic. We will contact you with the login and passcode for your group and the schedule.