FORMS
All clients are to complete the Client Information Form, Informed Consent, and Notice of Privacy Practice (NPP). You have the opportunity to read the Informed Consent and Notice of Privacy Practice (NPP) prior to your first appointment by clicking and downloading below. I will provide these forms to you to sign and read upon your arrival or you can print them and bring them to our appointment to save time. Please read below to know which questionnaires to complete in addition to the aforementioned forms.
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- Clients 18 and older receiving individual therapy are to complete the Adult Questionnaire.
- Clients ages 12 to 17 are to complete the Adolescent Questionnaire and the parents/guardians are to complete the Parent Questionnaire.
- Clients receiving couples therapy or whose chief compliant is marital/relational distress are to complete both the Couples Questionnaire and the Adult Questionnaire.
- All clients are to complete the DASS 42.
Please download and complete the questionnaires prior to your arrival and bring the questionnaire(s) to your appointment.
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Forms for Adult Clients
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Forms for Adolescents and Parents
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Forms for Couples
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Psychological Services, LLC
6200 Brooktree Road Suite 110 Wexford, PA 15090 Phone: 412-628-2818 Email: drchen@claritypsych.com |
Serving the North Hills area, including Wexford, Butler, Beaver, Gibsonia, Ross, Warrendale, Cranberry, Pine-Richland, McCandless, Mars, Allison Park, Franklin Park, Hampton, and Pittsburgh
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