Counseling Associates

Intake Packet/Forms

Our Intake Packet of forms will be sent out to you before your scheduled appointment.  Please complete all forms and bring them with you to your first appointment.

The Packet includes:

• Riverbend’s NOTICE OF PRIVACY PRACTICES, explaining your rights regarding confidentiality and our responsibility to you with regard to honoring and protecting your rights.
• Riverbend’s stated Client Rights and Responsibilities, informing you of your rights as a client, how to appeal any decisions staff may make about your care, where to call if you should have issues/concerns unanswered by the location providing services.
• Riverbend’s Consent to Receive Services with us, explaining financial responsibilities as well as responsibility to keep informed re: insurance changes, etc.
• Riverbend’s Health Screen Form, inquiring about your physical health and any medications you may be taking.
• Riverbend Counseling Associates Client Questionnaire to help us gain insight as to what is happening in your life and why you have decided to inquire about counseling, as well as whether there are specific issues you wish to address.
• Printed directions to Riverbend Counseling Associates office @ 278 Pleasant St. in Concord.

We thank you for completing these forms before coming to your appointment as it will save time to allow for a more complete session for your first visit.  It  will also allow you unhurried time to consider and express in writing your requirements for treatment as well as to review your rights with regard to treatment and any services you may receive with us.