Forms & Documents

Welcome to the therapy services of Vivian Morgan, MS, LCPC.
Your information and personal story is important to me.  I have created the following documents to gather information and to protect your privacy as we work together.

I ask that you read the following documents and sign the Signature Form for Therapeutic Services.  I will gladly answer any questions you may have around services, therapeutic practice, and record keeping at our initial Intake Appointment.

If I will be working with a child from a divorce or separation, please see the Statement for Therapeutic Role for these children and their parents below.

Please feel free to print your own copy of these documents. For your convenience they are here in both Word and PDF.

1.) Consent for Treatment

Consent for Treatment Form (Word)

Consent for Treatment (PDF)

2.) HIPAA documents

HIPAAprivacypractices HIPAAClientRights (Word)

HIPAAprivacypractices HIPAAClientRights (PDF)

3.) Statement of Therapeutic Role for Children of Divorce or Separation

Statement for Therapeutic Role in Separation and Divorce cases

Statement for Therapeutic Role in Separation and Divorce cases

4.) Signature sheet: This sheet attests that you have read and consent to the treatment considerations outlined in the forms above.

Signature Sheet: Sign-off for Therapy Services (Word)

Signature Sheet: Sign-off for Therapy Services (PDF)

5.) If you would like to complete the intake form ahead of your Intake Session you may.  Just please bring it, along with the signature sheet, to your first appointment.

Intake Form (Word)

Intake Form (PDF)

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