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(317) 413-9813 | adeprez@broadrippletherapy.com

Envision Counseling Services

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Client Forms

If you are new, please be sure to fill out the following forms, and bring them to your first session. This will help ease you in and allow as much time as possible to focus on you.

Authorization for release of information

Client Information

Client Intake Form

HIPAA Client Rights

HIPAA Notice of Privacy Practices

Informed Consent

Outpatient Services Contract

Envision Counseling Services
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(317) 413-9813

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