Children & Adolescents:
- Forms for new clients under the age of 18: Intake Paperwork
Child and Adolescent New Client Forms
- Please Note: Parent/Legal Guardian is responsible for minor and non-minor Children. If parents are divorced, Mason Family Counseling will not act as a mediator in settling claim/payment issues. According to Divorce Answers The parent that brings the child in for treatment is responsible for payment. Legally, we are not able to bill ex-spouses, regardless of divorce decree.
- Legal guardians can elect to use a payment authorization form or pre-pay the estimated amount due at the time of the session. Otherwise, guardians must accompany their children into the building to take care of their co-pay before the session. Co-pays must be taken care of prior to the appointment, or client will have to reschedule.
Forms for new adult clients:
- If coming in for marital or couples counseling, each party should fill out his/her own paperwork
Medication Evaluation / Management:
Forms for new medication clients:
The parent that brings the child in for treatment is responsible for payment. Legally, we are not able to bill ex-spouses, regardless of divorce decree.