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Before your initial assessment, I need you to fill out the following forms. Please print the forms and sign all of them except the client information form. If you plan to use my online service, fax or mail the forms to me, using the contact information at the bottom of this page. You can keep a copy of the HIPAA form and I’ll send you a copy of the disclosure after I’ve signed it. If you plan to see me in my office, just bring the forms with you to your initial assessment.
Client information
Disclosure
HIPAA privacy form
Financial information
Credit Card Authorization
Contact information: Julie Unger, LPC, NCC
6638 W. Ottawa Ave, Ste. 160-2
Littleton, CO 80128
Phone: 720-480-1428
Fax: 303-972-8081
julieunger@comcast.net
