FORMS
Find the form you need below.
Forms are organized by area of service. Please complete only the forms that apply to your work with me or that you have been directed to complete.
If you are unsure which form you need, please contact me before submitting.
BE HERE NOW MINDFULNESS, LLC
PSYCHOTHERAPY
NEW CLIENT FORMS
If you have scheduled an initual psychotherapy appointment, please complete these three forms before we meet. * Note: When completing the CLIENT INTAKE, it will not save your work if you close it out before submitting. So please complete in one sitting.
01
informed consent
Review practice policies, informed consent, confidentiality, and the nature of psychotherapy.
02
CLIENT INTAKE
Share background information, current concerns, and what brings you to therapy.
03
GOOD FAITH ESTIMATE
Review psychotherapy fees, estimated costs, and your rights under the No Surprises Act.
ADDITIONAL CLIENT FORMS
For established clients, as needed during the course of our work together.
authorization for release / EXCHANGE of information
Use this form when you would like me to communicate with another healthcare provider, therapist, physician, psychiatrist, attorney, school, or other person or organization involved in your care.
CLINICAL SUPERVISION + CONSULTATION
SUPERVISION AGREEMENT
For clinicians beginning a formal clinical supervision relationship.
CONSULTATION APPLICATION
For graduate-level clinicians who are not yet independently licensed and are interested in beginning clinical supervision.
PROFESSIONAL CONSULTING AGREEMENT
For clinicians seeking individual consultation related to licensure, ethics, regulatory questions, or other professional practice matters outside of an ongoing supervision relationship.
EDUCATION + CONTINUING EDUCATION
Participant agreements and continuing education documentation for Be Here Now Mindfulness programs.
PARTICIPANT AGREEMENT
For participants enrolled in designated courses, trainings, workshops, or other educational programs.
CONTINUING EDUCATION EVALUATION
Required for participants requesting continuing education credit following an eligible program.
KINTSUGI FACILITATOR COMMUNITY
CERTIFIED KINTSUGI FACILITATOR ADDENDUM
For participants who have completed the Certified Kintsugi Facilitator Training and are completing certification requirements.
OTHER FORMS
COACHING AGREEMENT / INTAKE
For individuals beginning coaching services.