PLEASE CLICK THE LINK BELOW TO BE DIRECTED TO YOUR CLIENT PORTAL TO PROVIDE PERSONAL INFORMATION AND HISTORY
FOR YOUR SCHEDULED INITIAL APPOINTMENT
If you are signing up for teletherapy sessions via video chat with Vicki Holoubeck due to our recent circumstances with COVID 19 please download the following form below. Then please read, sign, and then send back to her prior to your first session online. If she does not have this consent prior to the session, she will not be able to proceed with the session, and you will incur a late cancellation fee. You may send the form back via the email on this websites Contact me page or on your client portal at Therapy appointment. Please contact 402-880-9453 if you have any difficulties.
Below you will find 7 forms. Please read and familiarize yourself with the information that is in each one. If you have questions prior to your session please call me to discuss. You will be asked to sign a consent for treatment including signatures indicating that all of the forms have been given to you, and that you understand and agree to them upon your initial visit. If you will be participating in family or relationship counseling the other participants must read, print and sign the Collateral form below. Thank you and I appreciate your time in this matter.
|Collateral_form. (filled out by others participating in sessions such as relationship (spouses) and family members|
|File Size:||33 kb|
DO NOT PRINT ANY OF THE FOLLOWING FORMS (UNLESS YOU WOULD LIKE A COPY FOR YOURSELF)