Client Forms

North Central Client Forms

AUTHORIZATION TO DISCLOSE FORM - English

AUTHORIZATION TO DISCLOSE FORM - Spanish

Health Directions Appointment Information & Forms

In-Person Appointment Guidelines

  • Your Clinician will either greet you at the Health Directions entrance or in the waiting room* at your scheduled appointment time.
  • The entrance to Health Directions along with reserved parking, is located in the back of the NCBHS, Inc. building and is available for those receiving services at Health Directions.
  • The Health Directions door will remain unlocked at all times, therefore, if you are to arrive early to your scheduled appointment, please wait in the waiting room* located to the left of the Health Directions back entrance.
  • Please complete and review the following information/forms and bring them to your first appointment:
  1. Authorization for Treatment Form
  2. Authorization to Disclose Form
  3. Individual Information Form
  4. Privacy Practices
  5. Privacy Practices (Spanish Version)
  6. Privacy Practices Acknowledgment Form
  • Payment is expected at the time of your service and it will be your responsibility to complete any necessary pre-authorization with your insurance company.
  • You will be charged for any session that is not cancelled within 24 hours of your scheduled appointment.

 *The LaSalle office is the only location with a Health Directions waiting room.  At all other locations, your clinician will greet you at the Health Directions entrance at your scheduled appointment time.

       

 

 

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