top of page
LMFTI LOGO - 02-19.jpg

Therapy

Couple's

COUPLE - 3.jpg

The He + The She = The We

COUPLE - 1.jpg
COUPLE - 11.jpg
COUPLE -13.jpg
COUPLE SYMBOL - 4.jpg
COUPLE SYMBOL.jpg

SERVICES & FORMS

Therapy

Couples

Therapy

Individual

Therapy

Family

Notice of Privacy

Policy

HIPAA.jpg

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 Rights & Responsibilities

TEAM WORK MAKES THE DREAM WORK 4.jpg

Outlines your rights and responsibilities as a participant in therapy.

​

(Please click on the button below. The form will open in a new window for you to print and complete)

​

​

​

​

​

​

​

​

Cyber-Communications Policy

PHONE AND EMAIL3.jpg

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 

RIGHTS AND RESPONSIBILITIES 4.jpg

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

ONLINE COUNSELING 8jpg.jpg

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

COUPLE - 4.jpg

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

CONFIDENTIALITY.jpg

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

STRENGTHS AND CHALLENGES.jpg

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)

​

​

bottom of page