NEW CLIENT PACKET -

COUNSELING APPOINTMENTS

DIRECTIONS:

1. Read our "Privacy Notice"..

2. Print the "Confidential Data Form" (2 pages) and complete it in ink.

3. Print the "Privacy Practices Receipt" and complete it in ink.

4. Print the "Welcome New Client" form and sign and date the bottom

5. Bring completed forms with you to the Health Center for your appointment.

CONFIDENTIAL DATA FORM

PRIVACY PRACTICES RECEIPT

WELCOME NEW CLIENT

PRIVACY NOTICE