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Client Forms

If you’re a new client, please complete the following forms and send them to me via email or bring them to your first therapy session.

Full Spanish versions of forms are available in the Getting Started Menu

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Client Intake Form

Informed Consent

Client Privacy Rights and Acknowledgement of Receipt

Credit Card Authorization Form

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If you feel that you would like to collaborate your therapy with another provider, simply fill out the following form.

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Authorization for Release of Information

Claridad Community Services, Inc ccslicsw@gmail.com

(401) 524-1191 or Fax (401) 859-2215

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Terms and Conditions of Use: By submitting information via this web portal, you acknowledge and accept the risks of communicating your health information via unencrypted email and electronic messaging and wish to continue despite those risks. And that you agree to hold Claridad Community Services or Wix.com harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

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