Consent to Treatment and Confidentiality Forms

 

 

Before the first session please print:

Freedom Intake form

Please read:

Hippa Notice of Privacy

Please Print, sign, and text me this form

CONSENT TO TREATMENT

3rd party consent:

Release of Information 

Disclaimer

*Although she holds a Masters in Counseling, Rebekah is not a clinical counselor or psychotherapist. She is a Spiritual Adviser who adheres to ACA ethical guidelines and provides her services as a Breakup Specialist under the “Coaching” umbrella.