Clinical Service Forms
For all new clients
- Introduction to George W. Laws LCSW. SEP. EMDR. Provides information regarding Mr. Laws' past 40 years of professional experience.
- Client Intake Questionnaire. Provide information about yourself and your situation to assess suitability for service.
- Confidentiality and Cancellation Policy. Provides information regarding extent of confidentiality and cancellation responsibility.
- Application for George Laws Social Work Services LLC. A contract for service.
- Notice of Privacy Practices and Client Rights. Provides information for George Laws Social Work Services LLC practices, policies and the rights of the client.
Click on the appropriate form.
Printout each appropriate form.
Read the terms and conditions governing the services to be provided, and upon agreement, initial and sign each form.
If you have further questions, you may phone, text, or email your questions, or use the "Contact Me" link below. We can also discuss any questions you may have at your first session.
For Online Telemental Health Service
Read and sign these additional forms.
- Telemental Health Informed Consent. A contract for Telemental Health Services with specific HIPAA requirements and responsibilities outlined.
- Risk and Crisis Management Plans. A tool to address internet difficulties, risks to privacy and security, emergency planning, and HIPAA security.
Other Forms that may be needed
- Authorization for Use or Disclosure of Protected Health Information. The client authorizes their private health information to be shared with the provider.
- Dissociative Experiences Scale-II (DES-II). Assesses suitability of a client for a particular method or mode of treatment.
- Auto Accident Form. An instrument to focus upon the specifics of traumatization involving a motorized vehicle.
- Body Map Form. This instrument is used to show the locations of trauma in the body.
How to Return the Forms
For an in-person session - Complete the forms and bring them with you.
For an online session – Scan the completed and signed pages, creating a word doc or pdf file which will be transferred at the HIPAA secure clinic during the online session. I will assist you with this process during our first session.
Note: Forms are in PDF format. To download Adobe Acrobat Reader for free, Click here.