the forms

Informed Consent 2020

Informed consent is a document granting me permission from you before conducting a therapy. It outlines procedures about my practice and provides you information on your rights.

WellTherapySF Informed Consent 2020

HIPPA

HIPAA is the acronym for the Health Insurance Portability and Accountability Act that was passed by Congress in 1996. HIPAA does the following:

1) Provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs; 2) Reduces health care fraud and abuse; 3) Mandates industry-wide standards for health care information on electronic billing and other processes; and 4) Requires the protection and confidential handling of protected health information (MOST RELEVANT POINT FOR THERAPY CLIENTS)

WellTherapySF HIPPA

Client Questionnaire

The questionnaire is a document for all new therapy/coaching clients to be completed before the initial session. It is designed to address most areas of your life and provides a beginning place for therapy/coaching work to begin.

WellTherapySF Client Questionnaire

Authorization to Share

A medical release form is a document that gives me permission to share specific and relevant patient medical information with specific other parties. Under HIPAA regulations, it’s referred to as an “authorization.”

WellTherapySF Auth to Share

Copyright 2020. Ruth Krumbhaar, Marriage and Family Therapist MFC53637.