New Clients, please print and fill out the Counseling Agreement and the Intake Form to bring with you to your first appointment. For tele-health appointments please scan the completed forms and email them to me at: liz@ufringo.com.

Counseling Agreement

This document outlines uFringo’s confidentiality, payment, cancellation, termination and safety policies.  I must have a signed copy of the signature page on file before we can begin therapy.

Adult Intake Form

This document will provide me with your contact information, and also invites you to share information with me about your reasons for coming to counseling.  I will need this completed document before we can begin therapy.

Adolescent Intake Form

This document will provide me with your and your child’s contact information. I will need this completed document before we can begin therapy. Please provide your child with pages 2, 3, & 4 and an envelope so they know they are sharing their responses confidentially.

HIPPA Notice

This document explains uFringo’s policies in compliance with the national standards required to protect the privacy of your medical records and other personal health information.