Client Forms

Client Forms

If you are new, please feel free to fill out these intake forms before our first session. Telehealth sessions are conducted through SimplePractice, a secure HIPPA-compliant format.  Keep in mind, Renfro & Associates, LLC will see all patients regardless of their race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity. No one will be denied access to services due to inability to pay.  A discounted/sliding fee schedule is available.  In some instances, services may be free for you.  Contact me to learn more details! These forms can also be filled out during the first session.

Client Intake Form

Information Sheet

Limits of Confidentiality

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information