If you’re a new client, please complete the following forms and bring them to your first therapy session.
- Consent Signature Page
- Consent Disclosure (keep for your records)
- Parent Agreement (for minors only)
- HIPAA notice. (keep for your records)
- Developmental History (for minors only)
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
Physicians & Agencies:
may click here for a Referral Form that can be faxed to
(843) 407-6655 for Florence/ Lake City
(864) 203-3504 for Mauldin
or emailed to info@palmettofamilyworks.com
Financial Forms:
Note: To download Adobe Acrobat Reader for free, click here.