Forms

Protection & Consent

Living Hope accepts credit cards, cash and checks. We will provide a "superbill" as an out-of-network provider for possible reimbursement to you from your insurance carrier.

Please fill out and bring in to your first session: Adult History Form, Family Information Sheet, Informed Consent Form and the Authorization to Release Health and/or Confidential Information.

Click on the PDF button to download any forms you may need to fill out.

Informed Consent and Essential Forms for

Kristen Smith, LMFT, LISAC

Informed Consent and Essential Forms for

Erica Gores, LMFT

Informed Consent and Essential Forms for

Erica Gores, LMFT (for Child)

Informed Consent and Essential Forms for

Ashley Worthington, LPC

Informed Consent and Essential Forms for

Molly Caldwell, LMFT

Informed Consent and Essential Forms for

Molly Caldwell, LMFT (for Child)

Informed Consent and Essential Forms for

Briana Waggoner, LAC (with Supervision)

Informed Consent and Essential Forms for

Kenna McGrath, LAC (with Supervision)

Informed Consent and Essential Forms for

Aubrey Clark, LAC (with Supervision)

Authorization to Release

Health Information and/or Confidential Information