HIPAA Privacy Rights Forms
These forms summarize your rights under HIPAA.  It also includes a form for
you to affirm that you have been notified of your rights.
ECS Forms and Policies
Welcome to the Forms Page.
Simply click on the links below to see the form you want.  You may print them as well.
ECS Policies
All clients of ECS (except children less than 16 years old) must read
and sign this form.
Adult Intake Information Form
This form is 2 pages and is required for all clients 18 years of age or
older.  It contains demographic information and initial clinical information
for your therapist.
Payment - Insurance Agreement Form
This form is for anyone taking responsibility for the account whether or not
you are using insurance.  
Child / Adolescent Intake Information Form
This form is 2 pages and is required for all clients who are less than 18
years of age.  It contains demographic information and initial clinical
information for your therapist.
Divorced Parent Agreement Form (Green Form)
This form helps clarify which parent or both can authorize therapy and how
much of the account each will be responsible for.
Release of Protected Health Information
With this form, you can designate to whom you want your PHI to be released.
Arrive 30 minutes early at your first session to complete our intake forms or you can
complete your forms at home before your first appointment time
,

Adults (18+ years old)
Print and complete
each of the forms listed below:
   ECS Policies
   Adult Intake Information Form
   Payment-Insurance Form
   HIPAA Privacy Rights Forms

Children & Adolescents
(Special rules apply to 16 & 17 year olds.  See Child Counseling Policies Page for details.)
(Special rules apply if the child's parents are divorced.  Also see the Policy page above.)
Print and complete each of the forms below:
   ECS Policies
   Child/Adolescent Intake Information Form
   Payment-Insurance Form
   HIPAA Privacy Rights Forms
    (for Divorced Parents)  Divorced Parent Agreement Form
Child Confidentiality Form (Ages 0 - 15)
This form gives parents choices about how much confidentiality to apply
to their child in counseling.