Forms



Welcome! We are excited to begin working with you. Here you will find certain forms to fill out before your appointment with PCD Counseling. To make the most efficient use of your time, please print & complete the forms below and bring them with you to your first appointment. Your therapist will review them with you & answer any questions you have at the beginning of your session.

ALL CLIENTS need to complete the following forms:

1. Agency Record Form (for couples counseling, each person should complete this form)
2. Financial Form
3. Disclosure Form (Two Therapists’ Disclosure Forms are listed below. Others will be given at first meeting.)
   1. Ron Nydam’s Disclosure Form
   2. David DeBord’s Disclosure Form
4. HIPPA Form (1), HIPPA Form (2)

INSURANCE/EAP Clients need to complete the Insurance Form.

COUPLES THERAPY Clients need to complete the Couples Disclosure Form.

 

Are you working with your insurance company for your PCD services? Below is a list of helpful questions to ask your insurance company about your benefits.

Benefits Inquiry Questions