| FORMS MENU |
This is a document describing the privacy of information I follow in the delivery of my
services. It has to do with confidentiality. Please read this. There is nothing to fill out, but
it is important you read it prior to signing the treatment contract.
services. It has to do with confidentiality. Please read this. There is nothing to fill out, but
it is important you read it prior to signing the treatment contract.
All persons who receive treatment services from me must review and sign a treatment
contract. You may wish to review this prior to our first meeting but we will go over it
together before you sign it. This form is sometimes called an "informed consent" form
and includes information on rights and responsibilities. Although it reiterates some of the
information in the Privacy Policy, this is a signed document which states that you have
been informed of certain standard limits to privacy and are still consenting to treatment.
The limits to privacy are actually very few but by being informed, you can make better
decisions about what to, and what not to tell me. The only restrictions to privacy are those
required by law.
contract. You may wish to review this prior to our first meeting but we will go over it
together before you sign it. This form is sometimes called an "informed consent" form
and includes information on rights and responsibilities. Although it reiterates some of the
information in the Privacy Policy, this is a signed document which states that you have
been informed of certain standard limits to privacy and are still consenting to treatment.
The limits to privacy are actually very few but by being informed, you can make better
decisions about what to, and what not to tell me. The only restrictions to privacy are those
required by law.
This is a standard questionaire I ask most adults to fill out prior to our first session. For
those with concerns about their mental health, this will help us to get a good start in the
right direction. For those without mental health concerns per se, this will still be helpful
and it will help us rule out any mental health concerns which may not be initially apparent.
Please fill this out prior to our first session and bring it with you.
those with concerns about their mental health, this will help us to get a good start in the
right direction. For those without mental health concerns per se, this will still be helpful
and it will help us rule out any mental health concerns which may not be initially apparent.
Please fill this out prior to our first session and bring it with you.
This is the form you will need to fill out if you wish for me to bill your insurance company
for my services. If you are planning to use insurance to pay for services, please fill this
out and bring it with you to your first session.
for my services. If you are planning to use insurance to pay for services, please fill this
out and bring it with you to your first session.
This form is sometimes called a release of information (ROI). Under most circumstances,
I am not allowed to share information with others without your permission. This is the
form you will need to fill out and sign in order for me to communicate with other parties. If
you already know that you will wish for me to communicate with certain other people or
organizations, you may wish to print this page and have it ready for when you come in.
Examples of others you may wish for me to communicate with or receive records from
include medical providers, clergy persons, community organizations, other therapists, and
friends or family.
I am not allowed to share information with others without your permission. This is the
form you will need to fill out and sign in order for me to communicate with other parties. If
you already know that you will wish for me to communicate with certain other people or
organizations, you may wish to print this page and have it ready for when you come in.
Examples of others you may wish for me to communicate with or receive records from
include medical providers, clergy persons, community organizations, other therapists, and
friends or family.
This questionaire is to be filled out by parents or guardians when the adolescent is to be
the focus of treatment.
the focus of treatment.
| Christian Wolff, MA, Licensed Psychologist Associate/Consultant |
The following is a list of various documents and forms which you
may wish to view or print. The forms with an asterisk (*) are the
forms most people will need to review or fill out prior to our first
meeting. To view, click on the white high-lighted words. Brief
instructions are included in red. To print, you may print these
documents in the same way as you would any other document.
may wish to view or print. The forms with an asterisk (*) are the
forms most people will need to review or fill out prior to our first
meeting. To view, click on the white high-lighted words. Brief
instructions are included in red. To print, you may print these
documents in the same way as you would any other document.
This a form that establishes our agreement about payment. Whether I bill your insurance,
you bill your own insurance, or you pay me directly out of pocket, it is important that we
agree about fees from the beginning. This will help us avoid misunderstandings (or
unpleasant surprises). This form will need to be signed before we begin, but many people
choose to wait until they arrive and have had an opportunity to ask questions.
you bill your own insurance, or you pay me directly out of pocket, it is important that we
agree about fees from the beginning. This will help us avoid misunderstandings (or
unpleasant surprises). This form will need to be signed before we begin, but many people
choose to wait until they arrive and have had an opportunity to ask questions.
People come to therapy or to consultations for a variety of reasons. This is not a required
form, but it could be helpful in getting your consultation off to a productive start. It is
recommended that you at least read it and it is my preference that you fill it out and bring it
with you to your first session.
form, but it could be helpful in getting your consultation off to a productive start. It is
recommended that you at least read it and it is my preference that you fill it out and bring it
with you to your first session.
This is a simple "front page" which will give me easy access to your name, address,
contact numbers, emergency numbers, and so on. Please fill this out and bring it with you
to your first session.
contact numbers, emergency numbers, and so on. Please fill this out and bring it with you
to your first session.
| 820 NW 21st Avenue, Suite B o Portland, Oregon o 97205 o 503.284.4501 |
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This is a form that establishes our agreement about cancellations. Please read it and
click on the "Printable Page" link. Sign this page and bring it with you at the time of your
first session.
click on the "Printable Page" link. Sign this page and bring it with you at the time of your
first session.
