i to i Counseling

Individualized Services | Austin, Texas

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Forms

  • New Client Information and Agreement Form

  • Initial Form for Minors – This form must be completed and signed by both parents/legal guardians prior to the first session

  • Notice of Privacy Practices (HIPAA notice)

  • Teletherapy Information and Agreement

  • Informed Consent

  • Release of Information Form – if you are on medication, please fill this out so I can communicate with your doctor

  • New Clients, please enter Storm Medical Billing Information here if you use Blue Cross Blue Shield PPO

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Chris Quaglino, LCSW, LCDC -- 1507 North Street Unit 1 Austin, TX 78756 -- CALL 512-775-5940