Parakalein Counseling & Consultation Services

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FORMS

You can download any of the following forms in both Adobe Acrobat and Microsoft Word formats.  If you are a PC user, right-click over the document and "save link as..."  If, on the other hand, you are a MAC user, click and hold over the document and "save link as source."

 

Registration Form
Fill this out before the first visit.
Registration Form [15K] Registration_Form.doc [20K]
Contractual Agreement
Fill this out before the first visit.
Contractual_Agreement [9K] Contractual_Agreement.doc [22K]
Health Insurance Claim Form
Fill this out before the first visit.
CMS1500 [45K]  
Consent to Release Confidential Information  
Consent_to_Release [13K] Consent_to_Release.doc [21K]
HIPPA Release Form  
HIPPA_Release_Form [3K] HIPPA_Release_Form.doc [20K]
Application for Assistance Form  
Application_for_Assistance_Form [8K] Application_for_Assistance_Form.doc [21K]

© Copyright 2006-Parakalein Counseling & Consultation Services. All rights reserved.
251 New Karner Road, Albany, NY 12205 518-452-9919
2 Swamp Road, West Stockbridge, MA 01266 413-232-6144

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