719-481-8618

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    • Home
    • Forms
    • Contact and Map
    • Publications
    • Services
    • A New Parenting Approach

719-481-8618

  • Home
  • Forms
  • Contact and Map
  • Publications
  • Services
  • A New Parenting Approach

Gary Unruh, LCSW

Gary Unruh, LCSWGary Unruh, LCSWGary Unruh, LCSW

New Client Forms

Client Information (pdf)Download
Policy for Payment (pdf)Download
Disclosure (pdf)Download
Insurance Authorization and Guidelines (pdf)Download
Authorization to Release Information (pdf)Download

Client History Forms

Adult History Form (pdf)

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Child History Form (pdf)

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As a new client, you must review and understand your client rights:​  Health Insurance Portability and Accountability Act of 1996 (HIPAA)​.  


More information can be found on the U.S. Department of Health & Human Services website by CLICKING HERE. 

WE LOOK FORWARD TO HEARING FROM YOU

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