These are the downloadable forms for new clients. They may seem a bit involved, but just do the best you can when filling them out and don't worry about it. There is no right or wrong way to do this, it isn't a test. The reason there are so many questions on the forms is having this information up front saves time and money for you. It also makes for better sessions and faster results. They may seem a little personal, but all of the questions have a reason and a purpose. It seems like we may ask the same question in different ways, but with some people that is a good way to understand their circumstances and find out things we might miss at first otherwise, so if it doesn't apply to you just remember there are people where it does apply. If you are thinking you have never had to do all of this before you are probably right, some of this comes under the new health care act.
If you are a new client please download and fill out the New Client Intake Form and the New Client Preference Sheet. If you are a weight loss client please fill out the Weight Loss Intake Form and if you are coming to stop smoking please fill out the Stop Smoking Intake Form.
If you are currently being treated for a medical or mental health condition including substance abuse I will have to have a completed HIPAA Medical Release form to continue. This is the law and also the only ethical way to proceed. I want to be absolutely sure that anything we do is with the approval of your doctor or health care provider. A universal HIPAA Medical Release form is downloadable below.
These are pdf forms and you can print them out, fill them out and then scan them and email them to me at [email protected]. You can mail them to me at The Automatic Mind, P.O. 637 Winchester, TN 37398, but please send me an email or call me so I can know to check for them. When I get busy or I am out of town I don't check the post office box every day. If you can't do either then you can bring them with you when you come. If you can't download them then call and I will have a set for you to fill out before your set session time. I will work with you. It is best if you can fill these forms out when you have plenty of time and I can get them a day or two before the session to go over them, but I know the world isn't perfect so we just do the best we can and make it work for us. In the meantime, if you have any questions you might check the free section for downloadable question and answer sheets.
God bless,
I look forward to seeing you soon,
Scott
| New Client Intake Form |
| New Client Preference Sheet |
| Weight Loss Intake Form |
| Stop Smoking Intake Form |
| Universal HIPAA Medical Release Form |
DISCLAIMER
Many issues by their nature require Mr. Hogue to work with a doctor or mental health care professional. Mr. Hogue does not diagnosis or treat illnesses or diseases. Individual results may vary.
PRIVACY STATEMENT
We never, never share your email or other information unless required by law. All conversations are confidential. We do not use cookies or third party tracking software for marketing. You can visit our website anonymously. If you email us or enter your information in a form on this website it will only be used to contact you to reply to your email, answer your questions or add you to our newsletter if you subscribe. Clients seen in the office may download, print and fill out intake forms from this website and bring them in during their visit to avoid transmitting any information over the internet.
If you have any questions concerning privacy please feel free to contact me at [email protected] or by mail at P.O. Box 637 Winchester, TN 37398
Many issues by their nature require Mr. Hogue to work with a doctor or mental health care professional. Mr. Hogue does not diagnosis or treat illnesses or diseases. Individual results may vary.
PRIVACY STATEMENT
We never, never share your email or other information unless required by law. All conversations are confidential. We do not use cookies or third party tracking software for marketing. You can visit our website anonymously. If you email us or enter your information in a form on this website it will only be used to contact you to reply to your email, answer your questions or add you to our newsletter if you subscribe. Clients seen in the office may download, print and fill out intake forms from this website and bring them in during their visit to avoid transmitting any information over the internet.
If you have any questions concerning privacy please feel free to contact me at [email protected] or by mail at P.O. Box 637 Winchester, TN 37398
