PLEASE CONTACT VICKI HOLOUBECK, MS CPC LIMHP DIRECTLY TO SCHEDULE AN INITIAL APPOINTMENT BEFORE CLICKING THE LINK BELOW TO BE DIRECTED TO YOUR CLIENT PORTAL TO PROVIDE PERSONAL INFORMATION AND HISTORY
FOR YOUR SCHEDULED INITIAL APPOINTMENT.
PLEASE READ INSTRUCTIONS FOR SETTING UP CLIENT REGISTRATION AND PORTAL SET UP IN ORDER TO COMPLETE STEPS FULLY. After clicking on the button below you will be asked to put in your personal information which will register you as a new client. PLEASE NOTE: You will then be directed to check your email for a link to go to your personal portal and set up a username and password. Within the portal you will find a dashboard on your left hand side of the screen. Please click on documents and forms and you will find several medical forms. Please read and familiarize yourself with the information that is included in each of these forms. If you have any questions regarding any of the information included in the forms please call me to discuss. You will be asked to electronically sign each form indicating that the form has been given to you, that you have read and understand the information included in the form, and that you agree and consent to the information within the form. You may feel free to print any form with the content for your record. Please complete all forms prior to your initial visit, as sessions can not commence without consent and may result in having to reschedule and postpone your initial visit until this paperwork is finalized. If you will be participating in couples or family counseling, please have each member that will be participating in the session besides the client download the collateral form below. Please print it off, sign, and bring with you to the first session. Please enter your insurance information from your dashboard labeled insurance. Lastly, please fill out the biopsychosocial history for relevant background information. 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 |
| Consent_to_release_information11__1_.doc |
If you have any questions regarding the forms or the information above please /contact-me.html
