North Central Client Forms
AUTHORIZATION TO DISCLOSE FORM - English
AUTHORIZATION TO DISCLOSE FORM - Spanish
INDIVIDUAL RIGHTS & RESPONSIBILITIES
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:
- Authorization for Treatment Form
- Authorization to Disclose Form
- Individual Information Form
- Privacy Practices
- Privacy Practices (Spanish Version)
- 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.