· The New Client Form (Adult or Minor, whichever is appropriate)
· The Consent for Treatment
· The copy of our Privacy Practices
· The Service Fee Schedule
· Credit Card Authorization Form
If you are interested in online/teletherapy, you will also need to complete the Teletherapy Consent form
There are two ways to complete the new client forms. If you schedule an appointment, the administrative staff can set up your access to our online system for completing the required forms (Patient Portal). Most clients find this the easiest way to complete the required forms. Alternatively, you can print out and complete the New Client Forms and the Consent for Treatment, scan, and send via secure email on the Patient Portal system. Or you may bring the completed forms to your first in-person meeting. The Privacy Practices and the Service Fee Schedule are simply for your records; you do not need to bring a copy of this with you to your first session. Select from the following buttons for the appropriate forms.
***If you do not have a way to print out and sign the consent forms, you may electronically sign them before submitting them via our secure Patient Portal. Here is one way to do this:
If there is anyone with whom you would like your clinician to share information (a psychiatrist, medical doctor, caseworker, etc.) please complete a RELEASE OF INFORMATION FORM, being sure to include contact information.
If at any point during your relationship with our office you feel wronged, you may complete a GRIEVANCE FORM and submit it to ClearView's front office in Fairfield, in person, secure email via Patient Portal, fax or postal mail.
We would love to get your feedback on how you feel our front office, your clinician, and our office in general are doing. Please complete the FINAL CLIENT SATISFACTION SURVEY to help us improve our service to you and future clients. These surveys can be submitted to the front office in Fairfield or via our secure email on the Patient Portal system.
Our Patient Portal system is a secure, HIPAA compliant email system available to current or scheduled clients.
