​​Tonya Gilkerson, L.C.S.W.​

Documents

Initial Visit

To eliminate the need to complete the required documents during your first visit.  You have the option to print these forms and bring them with you.  If you have any questions, please feel free to contact me via phone, text or email.  Thank you.  

Initial Visit Packet: Individual

• Individual Treatment Consent
  
• Intake Form
• Notice of Privacy Practices (HIPAA) form
• Receipt of Notice of Privacy Practices (HIPAA) form

Initial Visit Packet: Minor

• Minor Treatment Consent
• Intake Form
• Notice of Privacy Practices (HIPAA) form
• Receipt of Notice of Privacy Practices (HIPAA) form

Initial Visit Packet: Couples

• Couples Therapy Treatment Consent
• Intake Form
• Notice of Privacy Practices (HIPAA) form
• Receipt of Notice of Privacy Practices (HIPAA) form

Other Documents

If your personal information has changed or need any additional forms, please complete any of the following to update my files.  

• Release of Information
• Authorization to Bill Insurance Form
• Emergency Contact Information
• Authorization to Secure Payment