Get Nc Kelly Harrison Macc Lpca Lmfta Client Disclosure Statement 2014-2025

This guide provides comprehensive instructions on filling out the NC Kelly Harrison MACC LPCA LMFTA Client Disclosure Statement online. It is designed to help you understand each section of the document and ensure you provide the necessary information accurately.

Follow the steps to complete the Client Disclosure Statement effectively.

1. Press the ‘Get Form’ button to access the Client Disclosure Statement and open it in your preferred document editor.
2. Begin by entering your personal information in the Client Demographics section. Fill in your first name, middle initial, last name, and date of birth. Ensure that all information is accurate.
3. Provide your Social Security number, address, and contact information including home phone, cell phone, and email address. Select your preferred method of contact from the available options.
4. Complete the section regarding employment status and marital status. Check the appropriate boxes that apply to you.
5. In the responsible party section, if it is the same as the client, write 'self' and proceed to the next section. Otherwise, provide the necessary information for the individual responsible for payment.
6. Fill out the emergency contact details. Include the name, relationship, phone number, and address of a person to be contacted in case of an emergency.
7. Review the acknowledgement page carefully and initial each statement to confirm that you have received and understood all information provided. Ensure you sign and date this section.
8. Complete the consent for treatment section by signing and dating where indicated. If applicable, provide the names of family members receiving treatment.
9. Final review: Go through the entire document to confirm that all fields have been completed accurately. Check for any errors.
10. Once you are satisfied with the filled-out document, you can save the changes, download the file, print a copy for your records, or share it as needed.

Start filling out your Client Disclosure Statement online today for a smooth counseling experience.