Stepping Stones Counseling Center, LLC


Moving Forward One Step At a Time

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Forms

Please print these PDF forms and fill them out prior to your first visit. If you don't have a PDF reader click here to download Adobe Reader.

SSCC Policies: This form explains SSCC Business Hours, Appointments, Fees, Insurance and Confidentiality. You don't need to print off this form but you may find some answers to some of your questions about what to expect in counseling.

New Client Form: This form is for new clients to print off and fill out so that your Counselor will know more about you and your family, your health, and your background. Fill out whatever you are comfortable sharing. If you have a spouse that is coming to counseling with you, both of you should complete a New Client Form so that we have information about each of you. If your child is the "client" put your child's information on the form.

Insurance Form: This form is for your insurance information and has our fee policy on it. You will need to print this off and fill in the information. Please bring your insurance card to your appointment or a copy of your insurance card - both the front and the back of the card. You will also want to check with your insurance company to see if you need a prior authorization.

If you have an Employee Assistance Program (EAP) through your employer, we still need a copy of your insurance card for our billing department to track your EAP provider, etc. If you have two insurance companies, please print off two forms and provide us with copies of both cards. The name and date of birth of the subscriber if very important for our billing company, as well as the social security number for many insurance companies.

Informed Consent Intake Form: This form is for you to print off and complete. This for that is called "Informed Consent" essentially lists your "Client Rights". Similar to a form you sign at the doctor's office these are about client confidentiality. You can ask your counselor if you have any questions or concerns about these rights.

Client Checklist (Adult): This form is a checklist for adults of how you are feeling at the time of counseling. Please feel free to add to the list, to indicate if these are recent symptoms or ongoing (and for how long you have been feeling these symptoms). Anything you feel you would like to make your therapist aware of would be helpful to include on this form. The only difference between the Adult form and the Child form is some of the wording. Parents can assist their child in completing the child form, as well, teenagers should determine which form they prefer to complete.

Client Checklist (Child): This form is a checklist for children of how you are feeling at the time at the of counseling. Please feel free to add to the list, to indicate if these are recent symptoms or ongoing (and for how long you have been feeling these symptoms). Anything you feel you would like to make your therapist aware of would be helpful to include on this form. The only difference between the Child form and the Adult form is some of the wording. Parents can assist their child in completing the child form, as well, teenagers should determine which form they prefer to complete.

Release of Information: This form is used when we need to contact your physician, attorney, school or another professional. Only print off this form if you feel there is someone we need to contact regarding your therapy. We can assist you in this so if you don't know, wait until you meet with your Counselor to determine if this form is needed.