Forms

• ASSIGNMENT of BENEFITS
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  Authorization for payment to be rendered to AFGO Counseling Resources, Inc for payment of services.
   
• INFORMED CONSENT & COUNSELING AGREEMENT
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  Agreement between client and counselor on the overall requirements and possible outcomes of the therapeutic environment. Describes Risk and Benefits of Counseling, Professional Counseling Services, Bio on Staff, Professional Fees, Payment, Billing, and Program Policies.
   
• IN TAKE FORM
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  Basic Demographic Information about yourself and family members. The information is confidential and will Not be Released without Your Written Permission.
   
• Notice of PRIVACY PRACTICES
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  This document contains important information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights with regard to the use of disclosure of Protected Health Information (PHI) used for the purposes of treatment, payment, and health care operations.