· The Facesheet (Adult or Minor, whichever is appropriate)
· The Consent for Treatment
· The copy of our Privacy Practices
· The Service Fee Schedule
Please print out and complete the Facesheet and the Consent for Treatment. 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 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.
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.