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 any Colorado residents are interested in paying for sessions without using insurance (i.e. Self Pay), please see the form below entitled "Good Faith Estimate Agreement." For any North Carolina residents interested in therapy, Self Pay is the only option at this time.
Clients Residing in Colorado
All of the forms with an * below are required for clients residing in Colorado. If you are unsure of which forms you need to fill out, please don't hesitate to contact Amber W. Pearson via email or text.
CO - Client Information - Insurance - IW[...]
Adobe Acrobat document [364.2 KB]
CO - Mandatory Disclosure Consent for T[...]
Adobe Acrobat document [397.9 KB]
CO - TeleTherapy Agreement Consent - IW[...]
Adobe Acrobat document [357.2 KB]
CO - Cancellation and No Show Policy - I[...]
Adobe Acrobat document [342.5 KB]
For clients who are Self-Pay (i.e.: people wo are not using insurance) the following form is required and includes options in accordance to Good Faith Estimate requirements:
CO - Client Information - Self-Pay - IWS[...]
Adobe Acrobat document [365.6 KB]
CO - Self-Pay Good Faith Estimate - IWS.[...]
Adobe Acrobat document [357.6 KB]
This form is not required for all clients, but is included if needed.
Clients Residing outside of Colorado
All forms with an * below are required for clients outside of Colorado. If you are unsure of which forms to fill out please contact Amber W. Pearson via e-mail or phone.
NC - Client Information - Private Pay - [...]
Adobe Acrobat document [343.9 KB]
NC - Professional Disclosure Statement -[...]
Adobe Acrobat document [459.5 KB]
NC - TeleTherapy Agreement Consent - IW[...]
Adobe Acrobat document [362.1 KB]
NC - Cancellation and No Show Policy - I[...]
Adobe Acrobat document [404.0 KB]
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