HOPE HAVEN COUNSELING
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​Forms

Picture
Intake Form
Please print and bring this completed form to your first appointment.
intakeform.pdf
File Size: 168 kb
File Type: pdf
Download File


Credit Card Authorization Form

​Every client must keep a credit card on file. Please print and bring this completed form to your first appointment.
creditcardauth.pdf
File Size: 30 kb
File Type: pdf
Download File


Notice of Privacy Form

Please print and bring this completed form to your first appointment.
notice_of_privacy_form.pdf
File Size: 89 kb
File Type: pdf
Download File


Notice of Privacy Practices 

Please print and keep for your records.
notice_of_privacy_practice.pdf
File Size: 98 kb
File Type: pdf
Download File


Payment Policy

Please print and keep for your records.
paymentpolicy.pdf
File Size: 86 kb
File Type: pdf
Download File


Hope Haven Counseling
11075 S. State Street Suite #14
Sandy, UT 84070
Office
801-676-8796
Fax 801-676-8797


copyright © 2015
  • Home
  • Services
  • Therapists
  • Contact
  • Crisis Numbers
  • Resources
  • Forms
  • Payment
  • Patient Portal