Family
Your family is worth fighting for
Therapy
Therapy
Couple's
The He + The She = The We
SERVICES & FORMS
Therapy
Couples
Therapy
Individual
Therapy
Family
Notice of Privacy
Policy
Your signature indicates that you understand your rights to privacy and the limited instances where for safety reasons it may be necessary to share information with another party per Florida Rules and Statutes.
(Please click on the button below. The form will open in a new window for you to print and complete)
Cyber-Communications Policy
Your signature on this form gives your consent for LMFTI staff members to communicate with you via cell phone, text, and email. These ways of communicating, though common, are not HIPAA compliant and will not protect your Personal Health Information. Therefore, these methods are limited to appointment reminders and crisis communications only.
(Please click on the button below. The form will open in a new window for you to print and complete)
Patient Info, Policies & Informed Consent
This form requests brief demographic information from you and lists key LMFTI policies for therapy. Your signature and initials indicate that you agree to the terms for LMFTI counseling services.
(Please click on the button below. The form will open in a new window for you to print and complete)
Telehealth Consent Form
Your signature on this form gives your consent for an LMFTI therapist to meet virtually with you for a therapy session using HIPAA compliant video-conferencing.
(Please click on the button below. The form will open in a new window for you to print and complete)
Couple's Consent Form
In couple's therapy, the patient of care is your relationship. In order to maintain fidelity to both of you and to your relationship, there are guidelines that must be agreed upon upfront-- namely, confidentiality, no secrets, and waiver of rights to subpoena therapy records for court purposes.
(Please click on the button below. The form will open in a new window for you to print and complete)
Limits of
Confidentiality
Your signature indicates that you understand your rights to privacy and the limited instances where for safety reasons it may be necessary to share information with another party per Florida Rules and Statutes.
(Please click on the button below. The form will open in a new window for you to print and complete)
Your Strengths & Challenges
It is said that our strengths are our challenges. We can't have one without the other. This form tells your therapist important reasons that have lead you to seek counseling and the assets and abilities you possess to meet your therapy goals.
(Please click on the button below. The form will open in a new window for you to print and complete)