Janet Elizabeth Akyol, LMFT, CSAT - Licensed Marriage & Family Therapist, MFC 51250

FORMS
 
NEW CLIENTS
 
Welcome to new clientsPrior to your first appointment you will need to fill out the forms below.  They inform me about your contact information, symptoms and history, and informs you about my services, your rights and the fee.   As the paperwork is extensive, for your convenience, copies can be accessed below in Microsoft Word format, and you may print them, fill them out, and bring them with you to your first appointment if you with.  Please print double-sided if possible.   If you do not wish to print these forms out, please arrive 15-20 minutes early to your first appointment to fill out and sign the required paperwork.
 
Please note, the files are read-only in order to maintain document integrity.  If you experience problems printing, such as asking for a password, please select Read Only.
 
 ADULTS

Intake Form (PDF — 94 KB)



NFInformedConsentPDF.pdf (PDF — 150 KB)

NFHIPPAPDF.pdf (PDF — 108 KB)


NFCancellationPolicy.pdf (PDF — 99 KB)


NFCreditCardOnFile.pdf (PDF — 100 KB)



COUPLES
 
Each person needs to fill out all of the above four forms.   In addition, couples need to fill out the form below.  You only need one of the "No Secrets Policy" forms per couple. 

NFNoSecretsPolicyPDF.pdf (PDF — 82 KB)
 
 
OTHER USEFUL FORMS

If you are under the care of psychiatrist or other mental health provider, you will need to fill out a Release of Information form if you would like your therapist to be able to release and/or exchange information with the other provider.