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Forms

The following are important forms required for your child's counselling records:

Intake Form

A document providing essential information about your child, including demographics, psychiatric and medical conditions, previous counselling, presenting issue(s), and treatment goals. This form is to be completed prior to attending your scheduled initial intake meeting. I will review this form with you and answer any questions you may have.

Information and Consent for Assessment and Treatment Form

This form provides essential information about the counselling process and its risks and benefits, limitations, confidentiality factors, fees, and scheduling and cancellation policy, as well as other important policies outlined by The Mindful Maple. It is essential that this consent form be reviewed, understood, and signed before I can begin counselling with your child. We will review this consent during our initial intake meeting and refer back to it on an as-needed basis.

Fee Agreement Form

This form is used to outline our agreement on fees for services, outstanding balances, and our cancellation policy.

Client Credit Card Authorization Form

To obtain services from The Mindful Maple, we require you to provide your credit card information, granting us the authority to automatically charge for professional service fees, such as late cancellations or missed appointments.

Authorization to Obtain Information Form

This form allows The Mindful Maple to obtain specific confidential information for the purpose of coordinating care with another professional involved with your child.

Authorization to Release Information Form

This form allows The Mindful Maple to release specific confidential information for the purpose of coordinating care with another professional involved with your child.

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