Resources for Established Clients

​Billing Update JotForm  (Click Here)    
The Billing Update JotForm is used when a current or returning client wants to update how they want to pay for their counseling services.  This form is commonly used when an insurance policy terms or a new insurance policy becomes active.

Good Faith Estimate-Private Pay ONLY (Click Here) 
The Good Faith Estimate JotForm is a federally (No Surprise Act) required JotForm, applicable to private pay clients only, that calculates the out-of-pocket cost for a year of weekly counseling services.

Client Authorization to Disclose Health Information (Click Here) 
The Authorization to Disclose Health Information Jotform is required when a client wants Mindful Counseling to share a client’s protected health information (PHI) for collaborative treatment, consultation, disability determination letter, etc.