INTAKE PAPERWORK

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INTAKE PACKET

Our Intake Paperwork Packet. All sections pertaining to the client must be complete. Any questions regarding intake paperwork can be directed to (614) 329-8862 or admissions@moderntherapyohio.org
This item must be completed and returned to admissions@moderntherapyohio.org or a Modern Therapy office for any counseling sessions to take place.

COVID-19 WAIVER

Modern Therapy's COVID Waiver. Signing this document assumes the liability and risk pertaining to the spread of COVID-19.
This item must be completed and returned to admissions@moderntherapyohio.org for any in-person counseling sessions to take place.

MODERN THERAPY PAPERWORK

Individual Pages for Client Convenience

 

PATIENT REGISTRATION

CONSENT TO TREATMENT

HIPPA AGREEMENT

CONSENT FOR CONTACT

CREDIT CARD AUTHORIZATION

NO SECRETS POLICY