Currently, I am not accepting clients needing marital therapy.

Hopelife Counseling
Hopelife Counseling
  • Home
  • Services Provided
  • Licensed Counselor
  • First Appointment Forms
  • Appointment Request
  • Make a Payment
  • Rates and Insurance
  • Location
  • Telehealth Information
  • Common Therapy Questions
  • Helpful Resources
  • More
    • Home
    • Services Provided
    • Licensed Counselor
    • First Appointment Forms
    • Appointment Request
    • Make a Payment
    • Rates and Insurance
    • Location
    • Telehealth Information
    • Common Therapy Questions
    • Helpful Resources
  • Sign In
  • Create Account

  • Bookings
  • My Account
  • Signed in as:

  • filler@godaddy.com


  • Bookings
  • My Account
  • Sign out

Signed in as:

filler@godaddy.com

  • Home
  • Services Provided
  • Licensed Counselor
  • First Appointment Forms
  • Appointment Request
  • Make a Payment
  • Rates and Insurance
  • Location
  • Telehealth Information
  • Common Therapy Questions
  • Helpful Resources

Account


  • Bookings
  • My Account
  • Sign out


  • Sign In
  • Bookings
  • My Account

Intake Paperwork

Please complete applicable forms and bring with you to your first appointment.  For those outside the Northwest Arkansas area, please complete and return TMH forms (below) prior to session.

Adult Intake Form - Required for Adults (pdf)Download
Informed Consent - Required (pdf)Download
Payment Agreement - Required (pdf)Download
Insurance Information - Required only for those using Insurance (pdf)Download
Minor Intake Form - Required for 17 years and younger (pdf)Download
HIPAA Notice of Privacy Practices - To review and understand (pdf)Download
Release_of_Information - Only needed for coordinated care (pdf)Download

Telemental Health Intake Paperwork

 Use these forms if you have requested an audio or video appointment (Telemental Health).

Please return the needed forms via email prior to the first appointment:  office@HopeLifeCounseling.com

TMH Adult Intake Form: Required for those 18 years or older. (pdf)Download
TMH Informed Consent: Required (pdf)Download
TMH Payment Schedule: Required (pdf)Download
Insurance Information: If you are going to use insurance, please complete this form. (pdf)Download
TMH Minor Intake Form: This form is for minors to be completed by parents. (pdf)Download
Check-In Instructions: A simple guide to help you check in online at your scheduled time. (pdf)Download

Copyright Notice

No part of this website or downloadable PDFs may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, photocopying, recording, scanning, or otherwise except as given permission by the website holder or by clients transmitting information back to the HopeLife office.

Health Insurance Portability and Accountability Act (HIPAA)

Please review this notice of uses and disclosures of your protected health information.

HIPAA Notice of Privacy Practices (pdf)Download

Copyright © 2018 Hopelife Counseling - All Rights Reserved.

Powered by