New Clients, please complete the forms below and bring them along with your insurance information, if available, to your first therapy session.
- Covid-19 Liability Waiver
- Client Psychotherapy Intake Form
- Treament Consent Form
- Insurance Form
- Credit Card Agreement Form
- Financial Hardship Form
- Price List
Synergy has it's own cancellation policy which you will receive in your welcome packet. It affords you the opportunity to make-up your session, void of losing any money or time.
If you would like Gina to coordinate care with another provider (psychiatrist, primary care physician, etc.), complete the form below, allowing authorization to release psychotherapy information.
- Authorization to Disclose Information Form
- Synergy's disclosure form is reviewed at intake.
Synergy of Spirit Counseling & Hypnosis Center is now offering teletherapy sessions. We have partnered with Doxy.me, LLC to ensure that all health rules & regulations are being adhered to. Please fill out the consent form below to participate.
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