© COVENANT FAMILY SOLUTIONS     |    1655 Blairs Ferry Road  |    Marion, Iowa    |    52302   |   319.261.2292

Phone Coverage: Monday-Friday 8:30-5:00

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THERAPY FORMS

INTAKE PAPERWORK

Select either the Child Paperwork or the Adult Paperwork file below, depending on who is the patient.

 

The first page is the Counseling Services Application, which will be helpful to us in completing the demographics section of your chart.

The next three pages (Informed Consent) contain all of the disclosures that are required to start therapy. You will need to review this information and sign at the bottom of the page, although this form will also be reviewed at the beginning of your first session with your assigned therapist.

The four pages after that are a packet entitled Biopsychosocial History. These should be reviewed and filled out with as much information as you can provide. The accuracy of these forms is important as it is used to help us conceptualize your presenting concerns and plan effective treatment. Time will be set aside during your first appointment to answer any questions you have about this paperwork.

The final page will be the the Release of Information, and only needs to be filled out if there is a third party you would like us to communicate with to coordinate care (e.g., a family physician).

 

FAMILY THERAPY AGREEMENT
This form is to be reviewed and completed by all parties in the family/couple involved in family therapy.
JOINT CUSTODY CONSENT AGREEMENT
This form is to be reviewed and completed by parents who have joint custody and are seeking services for their child after a divorce.
PATIENT'S RIGHTS AND RESPONSIBILITIES
The form below outlines what a patient can expect from services and what they need to contribute for a successful outcome.