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Telehealth Counseling 740.448.1604 - 740.592.5689

         No Office Visits -- Individual/Couples Teletherapy Counseling

Individual Intake Packet

 For individual counseling services, please send an email to [email protected] to request an intake packet.  

I will send you an electronic link to a client portal for you to access an intake packet from my electronic health record system, Simple Practice. 

 The link to access the portal will expire in 24 hours. It will take 30 minutes to complete the electronic documents.

I will contact you be email to schedule an intake appointment once the packet is complete. We will be meeting in the secure, HIPAA compliant, encrypted, telehealth platform of Simple Practice for your individual sessions.

Couple's Services

Billing information: 

Credit card information is to be provided by sending a picture of both the front and back of a credit card to the HIPAA compliant, encrypted email:

[email protected] 

The credit card information will be kept on file for billing. All services are charged at the beginning of the session.

COUPLES COUNSELING INTAKE FORMS

Each person in the relationship is to complete all forms in the billing and office practices section. 

DOWNLOAD AND PRINT OUT ALL FORMS FOR COUPLES INTAKE. Complete them and then email to the HIPAA compliant secure email: [email protected]

 Additionally, the couple are also required to email pictures of Ohio driver's licenses to establish identity and verify Ohio residence.  

We will be meeting in the HIPAA compliant, secure audio/video platform, gotomeeting, for your couple's sessions.

OFFICE PRACTICES, CONSENTS:

 Please email me at [email protected] if you have questions. 

 I am here to help you navigate the technology and the audio/video platforms we will use to meet in the connivence of your own home and to help the start-up of services to go smoothly.