FORMS

It is truly my honor to be serving as your Mental Health Therapist. These forms help ensure that you are receiving the best care possible as we move forward with treatment.

 

Before your first appointment, these forms will be email to you for review and need to be signed before therapy can proceed.
 

  1. Client Information Form - to be printed, completed and returned to counselor.

  2. Disclosure Statement -  to be printed, reviewed and signed.

  3. Oregon Notice Form of HIPAA Legislation - to be printed, reviewed and signed.

  4. If receiving couples counseling:  Couples Consent Form

 

**Please retain a copy of this information for your records.  If you are unable to print off these documents via email please let Shannon know and she will provide you with a packet in person or via mail.  Bring ALL forms to your first appointment or mail them to:

ATTN: Shannon Rants, MA, LPC
P.O Box 145, Canby, OR 97013

Shannon Rants

Licensed Professional Mental Health Counselor

Director of Come Arise Ministries

© 2018 by Shannon Rants
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Call

T: (seven-two-zero) 375-5146