Office Forms

 

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Levine

 

Welcome to the Inner-healing Web Site

hosted by F. Michael Montgomery, LCSW, LMFT

LCS 6184, MFC 15488

Therapy for the heart, mind, body and spirit in a safe and healing setting

This Inner-healing web site is a resource center for the support and promotion of personal growth and healing.

My desire is to support people in their own healing through the compassionate and courageous work of their hearts. 

 

Office Forms

These are the forms I use for my office. To save time, you may fill these out before the session. Just click on one of the form links below.  This will automatically launch your Adobe Acrobat Reader and display the form (if it does not launch, click here or on the Adobe button below to download a free copy of the Adobe Acrobat Reader®). Then print off the form! After printing a form, click on the Back Arrow in the toolbar at the top of the page to return to this page. 

For more detailed directions to download these files, scroll down to the bottom of this page or click here.

Three basic forms:
Intake Form
Office Policies Form
Client History Form

If a minor will be coming for therapy, please also fill out the

Consent To Treat Minor Form

If you have insurance that is covering therapy, please also fill out the
Insurance Information and Authorization Form  and the
PCP (Primary Care Physician) Request For Information Form

The following form is only used occasionally to share or obtain information
Authorization to Exchange Confidential Information

This form is used if you are using the internet or the phone for psychotherapy Telemedicine Informed Consent Form

To look at or download my brochure, click here

Directions to download these forms:
To download a file,
1) Left click on the link above to bring up the form; 
2) this will launch the Adobe Acrobat Reader
® with the form displayed; 
3) click on the printer icon in the menu at the top of the reader or click on the printer icon on your browser to print off the form.
After printing a form, click on the Back Arrow in the toolbar at the top of the page to return to this page.

If you do not have the Adobe Acrobat Reader®, it is available for free. To download the Reader, click here!

Please E-mail me with any suggestions, comments, or feedback you may have. I would really like to hear from you!

 

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F. Michael Montgomery, LCSW, LMFT
LCS 6184, MFC 15488
The Inner-healing Web Site
1209 College Avenue, Santa Rosa, CA 95404-3907
  (707) 578-9385   Fax: (707) 578-9271
Copyright © 1999          
fmm@inner-healing.com          http://www.inner-healing.com

This web site was created on 3-28-99