Please complete the following three required (electronic) forms before your first appointment:
Form 1: New Client Registration Form
This form is used to gather a basic profile of client’s contact information to register client in our system; assess your match to clinician(s) based on reason(s) for seeking counseling; and to gather insurance information so we can verify your benefits before your 1st session. Ultimately this form serves to streamline client onboarding.
*IMPORTANT: Please complete this form BEFORE booking an appointment. Thank you.
This form explains our expectations of you as a client, your protections and rights as a client, and our fees. Please read, and fill out client name, and emergency contact.
Form 3: Payment Authorization Form
This form serves as an authorization to input your credit card information
into our secure system and charge it when a balance on your account exists.
*All electronic forms are HIPPA compliant and ENCRYPTED which means your information is safe and secure.
Pink Positive Psychology
Located inside The Center for Natural Healing
1103 S. Washington Ave.
Royal Oak, MI 48067-3219
Day • Evening • Weekend
Copyright © 2017 Pink Positive Psychology. All Rights Reserved.