Couple by a Lake
Couple by a Lake

Helpful Forms

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If you're a new client, please complete the following forms and bring them to your first therapy session. *Please read all infomation on my Rates and insurance page, you will be asked to sign a form that you have read infomation and agree to conditions at your first appointment. Thanks in advance.

  • Client Psychotherapy Intake Form 
  • Limits of Confidentiality / Therapy Cancellation Policy

 

 

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

 

 

 

  • Authorization to Disclose Information Form

Forms for Elizabeth Detweiler - Anxiety, Depression, Stress Management, Parenting, Co-Dependency, Grief & Loss - Wake Forest, Raleigh, Wake Field, NC Client Psychotherapy Intake Form  
Forms for Elizabeth Detweiler - Anxiety, Depression, Stress Management, Parenting, Co-Dependency, Grief & Loss - Wake Forest, Raleigh, Wake Field, NC Limits of Confidentiality/Therapy Cancellation Policy  
Forms for Elizabeth Detweiler - Anxiety, Depression, Stress Management, Parenting, Co-Dependency, Grief & Loss - Wake Forest, Raleigh, Wake Field, NC Authorization to Disclose Information Form  
Forms for Elizabeth Detweiler - Anxiety, Depression, Stress Management, Parenting, Co-Dependency, Grief & Loss - Wake Forest, Raleigh, Wake Field, NCFor Medicaid Clients Only  

 

 

 


Substance Abuse clients only:

Forms for Elizabeth Detweiler - Anxiety, Depression, Stress Management, Parenting, Co-Dependency, Grief & Loss - Wake Forest, Raleigh, Wake Field, NC Self Evaluation Sheet  
Forms for Elizabeth Detweiler - Anxiety, Depression, Stress Management, Parenting, Co-Dependency, Grief & Loss - Wake Forest, Raleigh, Wake Field, NC Self Evaluation of Drug Use  
Forms for Elizabeth Detweiler - Anxiety, Depression, Stress Management, Parenting, Co-Dependency, Grief & Loss - Wake Forest, Raleigh, Wake Field, NC Barriers Questionnaire (Alcohol)  
Forms for Elizabeth Detweiler - Anxiety, Depression, Stress Management, Parenting, Co-Dependency, Grief & Loss - Wake Forest, Raleigh, Wake Field, NC Barriers Questionnaire (Drug)  


Note: To download Adobe Acrobat Reader for free, click here.


Elizabeth Detweiler - Anxiety, Depression, Stress Management, Parenting, Co-Dependency, Grief & Loss - Wake Forest, Raleigh, Wake Field, Durham, Apex, Cary, Chapel Hill, NC






 


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Helpful Forms

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