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Phoenix Rising Solutions, LLC

To Educate, Empower, & Enlighten

COUNSELING for PERSONAL &

RELATIONAL GROWTH

Jennifer Falbo-Negron, LCPC/LMHC, RYT-500, SEP

COUNSELING FORMS 

For new clients, there is an option to utilize our client portal system to fill out all the required client forms electronically before your initial appointment.  First, you would need to initiate contact using our short contact form on our Contact Us page regarding services with us. Next, we would schedule a free 15-minute, phone consultation. If it is determined that we would work well together, a one-way welcome email would be sent out from our client portal with a link that will give you access to the online forms.  The process of completing the forms ranges between 10-20 minutes depending how long it may take you.  The Intake Client Therapeutic Questionnaire form is not electronically filled out due to the comprehensiveness of the form and for your privacy; there are instructions on how to send that back to our office in the welcome email.


As another option, there is still the opportunity to download all of the forms below (5 in total), but most have found the online format to be more streamlined.  If you desire to download the forms and fill them out by hand or with the use of a pdf editing system, you would then send all the completed forms back to us prior to your initial visit. (Instructions will be provided during the consultation). First, fill out the short contact form on our Contact Us page before filling out any of these forms below and so that we can schedule your initial consultation.


Kindly let us know if you have any questions regarding information on the forms. We can be reached at 630-526-4325. Thank you for your interest in Phoenix Rising Solutions, LLC.

Additional Forms since COVID-19

We are providing both telehealth and in-person services, during the Coronavirus. We require both additional forms to be filled out prior to your appointment. Thank you for your cooperation.


We can help you set up telehealth services on your smart phone, desktop computer, laptop computer, and/or tablet with a camera and speakers.  We are currently using Zoom (HIPPA-compliant) for video and telephone calls.  Let us know how we can assist you or if you have questions.

 

Informed Consent for Telehealth Services Form pdf


Informed Consent for In-Person Services during COVID-19 Form pdf