FORMS

 

              If you would like the opportunity to read and fill out forms prior to your first appointment, please see the instructions

below.  Otherwise, we will give you the forms upon your arrival to our office and ask you to complete them in our waiting room. 

 

Form Instructions

 

1. Select which heading applies to you, and fill out the first form, Client Data Sheet.  (Couples clients should fill out a separate Client Data Sheet for each partner.)

 

2. Please read the Client Confidentiality and Information for Clients documents.  We will go over them during your first session to clarify any points you did not understand and answer any questions you may have.  (For adolescent clients, the adolescent should read the Information for Adolescent Clients form, and the parent should read the Information for Parents form.)

 

3. Please fill out and sign the Informed Consent form to acknowledge that you have received the above information.  (For couples clients, both partners should sign; for adolescent clients, the parent should sign.)

 

4. Please retain the HIPAA Notice of Privacy Practices (NPP) document for your records, and sign the HIPPA NPP Consent form to acknowledge that you have received it.  (Only one client’s signature is required.  Leave the “Witness Signature” line blank.)

 

5. Please bring the completed forms to your appointment.

 

Integrity Psychological Services provides comprehensive counseling, therapy and psychological treatment services for the communities of Monroeville, PA, Murrysville, PA, Plum, PA and surrounding Pittsburgh areas in Allegheny and Westmoreland counties.