Client Therapy Forms

If you are seeing one of us in Minnesota, or John in Nevada, or if you are signing up for the Reno ClearLife Clinic, and you want to access and print out the .pdf (Adobe Acrobat) file containing all of the necessary documents and forms... Click Here

Click Here For Insurance Information

Explanation of Client Therapy Forms

Clients who see us for individual, couple, family, group psychotherapy,  must fill out and bring to the first session the following forms, which can be accessed by clicking on the links above. For the ClearLife Clinic, print out these forms and mail or fax them to us as part of your application.

1. Intake Form (4 pages)-- Must be filled out completely and signed

2. HIPAA Privacy & Patient Agreement Signature Forms (One signature page acknowledging that you received and agree with our HIPAA Privacy Notice and our Patient Services Agreement. The Privacy Notice and Patient Services Agreement will print out along with these other forms.

3. Release of Information Form for your most recent therapy, or for your physician, psychiatrist, clinic, treatment program, etc. if applicable.

4.  2018 Men's Group Rules/Contract Signature Form required before participation in one of John's men's groups.

I