First Session Forms
For your convenience, I am including a downloadable packet with the forms you will need to fill out before your first session. This will save you some time. In order to preserve your confidentiality, you can print them and then complete them by hand. Remember to bring it with you when you come for your first session. If you are coming for couples counseling, each partner needs to complete forms packet*.
These are the documents that you will find:
- Informed Consent: This document provides information about your rights and responsibilities as a client and my responsibilities as a counselor. It also provides information about professional fees, collects information about your health insurance (if applicable), and obtains consent to receive treatment. Once completed, I'll be glad to provide you with a copy of this document for your records on your first visit.
- Confidential Questionnaire: This questionnaire gathers information about your medical and relational history and will assist me in understanding how to assist you. It will become part of your confidential file.
- Notice of Privacy Practices: This document provides information about how I will protect your health information in order to comply with the Health Insurance Portability and Accountability Act (HIPAA). You can keep this for your records.
To download the Informed Consent, the Confidential Questionnaire, and the Receipt and Acknowledgment of Notice of Privacy Practices, click here (Please, remember to bring this document with you to your first session.):
To download, read, and print the Notice of Privacy Practices, click here (There is no need to bring this document with you to your first session. You can keep it for your records.): Notice of Privacy Practices
Please, let me know if you have
any problems with the download or if you have any questions about the
documents. If you can't reach me immediately, please leave me a
voicemail or send me an e-mail and I will get back to you as soon as
possible. You'll find my contact information below.
Thanks for taking the time to
complete these forms.
*You will need Adobe Acrobat Reader software to view these documents. If you don't have this software, you can download it free by clicking here.
Luis G. C. Ortega, LMHC, NCC
2170 W. State Road, Suite 214
Longwood, FL 32779
(407) 536-7551
