Forms
Initial Paperwork:
First-time clients please print and fill out all relevant forms for the type of service you will be receiving and bring them to your initial consultation session.
Individual, Couples, and Family Clients
If a couple or family, EACH client over 15 years of age needs to fill out and sign a separate set of these documents. Parents would fill out and sign the documents for children under 15.
Group Therapy Clients
- Group Client Information Sheet
- Therapist / Patient Services Agreement - Group Therapy
- HIPAA Privacy Notice
Psychological Assessment Clients
- Psychological Assessment Client Information Sheet
- Psychological Testing Agreement
- HIPAA Privacy Notice
Additional Forms:
These forms are not required but may be useful in advancing your treatment.
If you would like to pay by credit card, you will need to fill out this form. You can pay via credit card once or on a continuous basis. You will need to fill out this form again only if you change the frequency of credit card payments or if the credit card information changes.
By filling out this form, you are authorizing Center for Valued Living, PLLC to consult with other people, whom you specifically select, about your treatment (e.g., physicians, lawyers, school personnel, family, etc.). You and Dr. Griffiths would discuss the nature of the information discussed with these other people before she initially consults with them. Consultation with anyone other than the person or people in treatment cannot occur without this written consent.
This form is used to request a reduced fee for those who are experiencing economic hardship. More information about the Sliding Scale opportunity can be found on the Fees and Payments page or within the applications themselves.
This form is for parents of minor children to acknowledge CO laws re: right to consent to treatment and access to records. Divorced parents with full or joint custody will need to sign and provide legal documentation of custody agreement with respect to each parent's right to make decisions about mental health treatment. Custody evaluations are not conducted at Center for Valued Living, PLLC; opinions about custody will not be provided by CVL staff under any circumstances.
Note: Adolescents between 15-18 can fill out the above forms for individual or group therapy and those forms do not require parent signature; however, they should be aware that parents can legally access their records until they turn 18.
You will need Adobe Acrobat Reader to view these PDF forms.