Healthy Perspectives 
208-603-7514
Home
About Jeremiah
Podcast
Services
Contact Us
Forms
Payment
Tour the office
Employment Opportunities
Healthy Perspectives 
208-603-7514
Home
About Jeremiah
Podcast
Services
Contact Us
Forms
Payment
Tour the office
Employment Opportunities
More
  • Home
  • About Jeremiah
  • Podcast
  • Services
  • Contact Us
  • Forms
  • Payment
  • Tour the office
  • Employment Opportunities

  • Home
  • About Jeremiah
  • Podcast
  • Services
  • Contact Us
  • Forms
  • Payment
  • Tour the office
  • Employment Opportunities

Printable Forms

The following forms are printable in PDF format. Please print and bring to your first session if possible. It saves us time in the session so we can spend our time getting to know one another. Some forms are available in fillable form below. If you don't know how to respond to a question, please leave it blank.  

2 Client information questions print version (pdf)Download
3 Professional_Disclosure_Statement (pdf)Download
4 Informed Consent (pdf)Download
5 HIPAA print version (pdf)Download
7 Release_of_Information (pdf)Download
HIPAA NPP for your records (pdf)Download
card on file form (pdf)Download

Fillable Forms

 Some of my forms are available to be filled electronically and can save us time in session. If you complete these electronically, please bring them to session or email them to me prior to your first session. If you don't know how to answer a question, please leave it blank.

2 Client information questions electronic fill in (dotx)Download
3 Professional_Disclosure_Statement electronic version (dotx)Download
5 HIPAA electronic version (dotx)Download
Bio psyc soc - Only fill this out if asked to do so. (dotx)Download
card on file form (dotx)Download
  • Employment Opportunities

Healthy Perspectives Inc

1205 Hwy 2, Suite 302

208-603-7514

Copyright © 2021 Healthy Perspectives Inc - All Rights Reserved.

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