Integrated Wellness and Strategies, LLC
Integrated Wellness and Strategies, LLC

Client Forms

New clients will need to fill out several forms before therapy can begin. To make the process as smooth and efficient as possible, these documents may be downloaded from the below list. Naturally, all forms are also available at the office but filling them out in advance saves time if you are able to. You will need Adobe Reader to view these PDF files. If you do not have it, you can download it here for free.


For anyone interested in paying for sessions witout using insurance, please see the form below entitled Good Faith Estimate Agreement.

All the forms with an * listed below are required for all clients.  If you are unsure which forms you need to fill out, please don't hesitate to contact me.

*Client Information Form
Client Information - Insurance - IWS.pdf
Adobe Acrobat document [392.7 KB]
*Mandatory Disclosure & Consent for Treatment
Mandatory Disclosure Consent for Tx - I[...]
Adobe Acrobat document [400.5 KB]
*Media Policy
Media Policy - IWS.pdf
Adobe Acrobat document [349.4 KB]
*Cancellation & No Show Policy
Cancellation and No Show Policy - IWS.pd[...]
Adobe Acrobat document [339.1 KB]
*HIPAA Privacy Rights
Adobe Acrobat document [391.9 KB]
*TeleTherapy Agreement & Consent
TeleTherapy Agreement Consent - IWS.pdf
Adobe Acrobat document [355.1 KB]
*Emergency Contact
Emergency Contact ROI - IWS.pdf
Adobe Acrobat document [324.4 KB]

For clients who are Self-Pay (i.e.: people wo are not usin insurance) the following form includes options in accordance to Good Faith Estimate requirements:

Good Faith Estimate Agreement
Self-Pay Good Faith Estimate - IWS - 202[...]
Adobe Acrobat document [355.1 KB]

This form is not required for all clients, but is included if needed.

Release of Information
Release of Information - IWS.pdf
Adobe Acrobat document [415.8 KB]

Service Provision

Only teletherapy (online/virtual) services are being provided. No in-person services are available at this time.


Amber is a Licensed Professional Counselor (LPC) in Colorado, a Licensed Clinical Mental Health Counselor (LCMHC) in North Carolina, and a Licensed Mental Health Counselor (LMHC) in Washington state and can provide services in any of these states. Amber can also provide services to clients who reside in states that don't require a license in that state for Teletherapy service provision.


Contact Information


Colorado Address:

5150 W. 120th Ave, Suite 100, #1057

Westminster, CO 80020


North Carolina Address:

2509A Lewisville Clemmons Rd. #1033

Clemmons, NC 27012


Phone: 720-644-6378


Fax: 720-446-3520

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