FORMS

CLEAR COUNSELING ST. LOUIS

All new clients are required to complete a welcome package. The welcome package includes:

• Clear Counseling St. Louis Client Agreement
• Insurance Form (if necessary)
• HIPPA Privacy Form
• Therapy Questionnaire
• Payment Authorization Form

The welcome package helps us take care of necessary procedure as well as set some ground rules for the work we are going to complete together. The Therapy Questionnaire is an important tool to help us begin our work and should be filled out honestly. There are no wrong answers and it is really just a reference point to begin our conversation. If you have any questions or would like access to documents individually please download below.

Please submit completed documents to karen@clearcounselingstl.com or bring with you to your first appointment. *I only require pages requiring action (signature, submission, etc.).

Clients looking to take advantage of insurance benefits and process payment through their insurance provider are required to complete additional steps detailed on our insurance page.

*All clients are responsible for meeting deductibles and handling copays directly with Clear Counseling St. Louis. Payment methods accepted include all major credit cards, apple pay, and cash.