Client Forms
For your convenience and to save time before your first appointment, we have provided the required forms that you will need to complete for your first appointment. By completing the documents before you arrive, you prevent the need to arrive early for paperwork.
Electronic Online fill-in form:
1. Click on the appropriate individual forms.
2. When the files open, you can enter each highlighted entry field electronically.
3. After filling in, download/save the files to your device (computer/phone/tablet). You can make changes to the file while it's still open, or after it's been closed you can make changes in your saved file.
4. If you used the electronic signature (available only if you use Adobe Acrobat to open and enter your information), you can email the files to us at info@hoxworthcounseling.com.
5. To manually sign each form, print them, sign them, and then bring them with you to your first appointment.
Print & Manually fill-in form:
1. Click on the appropriate form files.
Note: For convenience and quicker opening and printing, the New Client Forms Packet file contains all the individual forms, so you would only need to open that one file instead of each individual file.
2. When the files open, download/save them to your device (computer/phone/tablet).
3. Print each form, fill them out, sign them, and then bring them with you to your first appointment.
ADULT Client
Electronic Online fill-in forms
(allows you to fill in electronically, save, print, email)
1. Cover Letter
3. Authorization for Scheduling, Billing and Payment Purposes
4. Consent to Self-Pay Fee Sessions
5. Application for Sliding Scale Fee
7. PF1000 Notice of Privacy Practices
10. Notification & Coordination with
Primary Care Physician-Psychiatrist
Print and manual fill-in forms
Adult New Client Forms Packet - Print & manual file in
Packet includes following individual forms:
1. Cover Letter
3. Authorization for Scheduling, Billing and Payment Purposes
4. Consent to Self-Pay Fee Sessions
5. Application for Sliding Scale Fee
7. PF1000 Notice of Privacy Practices
MINOR CHILD Client
Electronic Online fill-in forms
(allows you to fill in electronically, save, print, email)
1. Cover Letter
4. Authorization for Scheduling, Billing and Payment Purposes
5. Consent to Self-Pay Fee Sessions
6. Application for Sliding Scale Fee
8. PF1000 Notice of Privacy Practices
10. Child/Adolescent Intake Form
11. Notification & Coordination with
Primary Care Physician-Psychiatrist
12. Notification & Coordination with Education Professionals
Print and manual fill-in forms
Minor Child New Client Forms Packet - Print & manual fill in
Packet includes following individual forms:
1. Cover Letter
4. Authorization for Scheduling, Billing and Payment Purposes
5. Consent to Self-Pay Fee Sessions
6. Application for Sliding Scale Fee
8. PF1000 Notice of Privacy Practices
10. Child/Adolescent Intake Form
11. Notification & Coordination with
Primary Care Physician-Psychiatrist
12. Notification & Coordination with Education Professionals