Forms

By you filling out these forms ahead of time, it gives us more time to talk about why you are coming in and less time filling out the paperwork. However, if you cannot print or are having trouble viewing these, please contact your therapist and we can work with you to get these. It is NOT a problem if you don’t have these, please just come  ten (10) or fifteen (15) minutes early so you can fill them out before session.

If you’re a new client, please complete the new client paperwork as well as your therapist’s disclosure form below and bring them to your first therapy session. Each member of the family that will be participating in therapy needs to fill out a registration form and the checklist of concerns.

New Client Paperwork:
Adult Registration
Child/ Adolescent Registration
Client Checklist of Concerns
Credit Card Authorization
HIPPA form
Emergency Contact list

Your Therapist’s Disclosure form: PLEASE ALSO PRINT THIS OUT
Jessica Edmonds, MA, LPC,  please also fill out her Disclosure form-JE.
Rose Monk, MA, please also fill out her Disclosure form-RM.
Atsede Scarseth, BA,  please also fill out her Disclosure form-AS
Danielle Vicaro, BS, please also fill out her Disclosure form-DV

Other pertinent forms (Optional)

If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to consent release of psychotherapy information.

If you would like us to share information with someone other than a provider (for example, your teacher, family member, friend, attorneys, Department of Human Services, employer, etc.), complete this form to authorize release of psychotherapy information.

Address

Brightside Counseling Services, LLC
12835 E. Arapahoe Rd. Suite 2-440
Centennial, CO 80112
USA
303.353.9226
jedmonds@brightsidecounseling.net

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Brightside Counseling Services, LLC
jedmonds@brightsidecounseling.net  |  303.353.9226
12835 E. Arapahoe Rd. Suite 2-440, Centennial, CO 80112