Jennifer S Bailey, MA, LMFT
MFC# 52363
Psychotherapy for individuals seeking more from their life
Forms
Here's where you can find some of the paperwork I require for all new clients. Please print off these forms and complete them beforehand to save time. Bring the completed forms with you to our first session to avoid delays. If you are a Telehealth-only client, please see the Acknowledgement & Consent to Use Electronic Communication form for instructions about how to download, fill out, and email these forms via a HIPAA-compliant, encrypted system so we can begin.
Client Information Form
This form provides me with all of your necessary contact information. It also gives you the chance to tell me a little about you. There is a brief questionnaire about your presenting issues and space to tell me what you'd like to accomplish in treatment. Please fill it out entirely to the best of your ability. It will help me immensely as we begin our work together.
Office Policy/Informed Consent
This form gives me your consent to begin treatment. It also gives details about how I work, what my qualifications are, and what you might expect from treatment.
My Social Media Policy
Like it or not, it's a digital age. Most of us live online, and therapists are no exception. In this form you will learn about my policy in regards to Facebook, Instagram, Twitter and all things Social Media, as well as how my profession's ethical guidelines and my own concerns in keeping your confidentiality will affect how we do or do not interact online.
Acknowledgement & Consent to use Electronic Communication Form
This form outlines the instructions and guidelines for the use of email/texting, and obtains your consent. This is especially important for Telehealth-only clients as we will have no other way of exchanging the paperwork necessary to begin treatment.
Consent for Telehealth Form
Life happens... Sometimes you may not be able to come in for your regular session, but still want to be seen. Sometimes our schedules won't mesh, sometimes you can't do a makeup session at another time during the week, or maybe we get hit by a massive Pandemic...😷 When that happens, sessions occasionally may need to be done over the phone, or over an encrypted, HIPAA-compliant App.
Release/Exchange of Confidential Information
This form is here for convenience as a "just in case." If you become a client, at some point you may be directed here to download this form if an exchange of confidential information is needed from a doctor, psychiatrist or other therapist. This is the one form here that is NOT needed for a first-time visit. If it is needed, we will discuss its use and necessity beforehand.