Client Forms
The Center for Vitality and Balance uses an electronic health record system (EHR) called Simple Practice. Most of the forms required to furnish services to clients are available through the EHR client portal. Electronic versions of the forms are preferred as it provides the highest level of security and privacy of your protected health information (PHI).
General Forms
Credit Card Authorization
Informed Consent for In-Person Services During COVID-19 Public Health Crisis
Insurance Forms
No Surprises Act Psychotherapy Forms
HIPAA Privacy Notice
Client Information
Informed Consent
Telehealth Informed Consent
Telehealth Recommendations and Technology Requirements
Walk and Talk Informed Consent
Authorization for Release of Patient Information
Medication Form
Client Email Agreement
Client Text Messaging Agreement