Resources for Established Clients

​Client Contact & Information Update Jotform (Click Here)
The Client Contact & Information Update Jotform is how current clients provide or confirm their current contact and general information.  Mindful Counseling will ask current clients to update their information, annually.    

​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 Jotform - Private Pay ONLY (Click Here)
The Good Faith Estimate Jotform is a federally (No Surprise Act) required Jotform that estimates the out-of-pocket cost for a year of weekly counseling services.  The GFE Jotform is only applicable to private pay clients is not applicable to clients who are utilizing insurance to pay for their counseling appointments.

Client Authorization to Disclose Health Information Jotform (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.