Susan E. Folwell, LLC, LCSW, LICSW, BCDV -

Primary Forms
To facilitate the best use of  the initial intake and evaluation session please download and complete the following forms prior to your appointment.

Policies and Procedures:  This document must be brought to the first session.  It contains important information about Susan's professional services and business practices. 
Financial Agreement:This document contains important information about fees and agreements between client and therapist.  It must be signed prior to the first session.
Confidentiality Statement:  This document is needed for the first session and contains important information about confidentiality and any mandated limits of confidentiality that may arise in psychotherapy.
Medicare Opt-Out:  This document contains information regarding therapist's non-participation in Medicare and must be signed and brought to the first session.
New Client Information: This document is needed for the first session in order to provide basic background information.
HIPAA form:  please sign acknowledgment of receipt of notice of HIPAA.

Additional Forms if Needed
Authorization for Release of Information: This form must be completed and signed if you would like for Susan to speak to another person regarding your treatment.  This may include a psychiatrist, another therapist, an attorney, a close family member, a medical professional, etc.  With a firm commitment to confidentiality, Susan will not acknowledge anything about your treatment, including whether or not you are even in treatment. 

Consent to Treat a Minor: form must be filled out before providing treatment to a minor client (less than 18 years old) by any parent or legal guardian who has legal custodial rights for the minor client. Upon occasion, especially in cases where litigation is a concern, Susan reserves the right to request a copy of custodial documentation to be included in the client file.