Claudine Miller, LPC

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Forms

On this page you are able to view and download forms and informational materials. If you would like to print and then fill out the Client Information and Consent to Treatment forms prior to your first visit, it will save some time. However, you are welcome to arrive early for your appointment and fill them out at the office. Printed copies will be available for you.

Click on the appropriate link to view and/or download the files. Some computers will require right-clicking the link and then choosing to Save Link. All files are in PDF format readable by Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader, it is available free at http://get.adobe.com/reader

  • Client Information Form – This form asks for some basic information about you
  • Consent to Treatment Form – This form is our agreement to start treatment
  • Client Release of Information -This form gives us authorization to request/obtain information
  • Information Pamphlet – This covers everything you need to know about treatment with me
  • Notice of Privacy Practices – brief Statement – This explains HIPPA
  • Client Bill of Rights Statement – This explains your rights as a client

Or choose to download a combined file of all forms at once here

Connect with Claudine

To contact Claudine for a free 15 minute phone consultation, please call or text 314-780-8328.

Email Claudine cmiller@claudinemiller.com

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