Forms

Mimosa Christian Counseling Center

Welcome to our initial visit preparation page. Here you will find most of the forms that you will need to fill out prior to your initial visit to our office. We want to give you all the time you need to read this information and fill out the forms at home, which will make the preparation for your office visit more relaxing. Please bring the filled-out forms with you, along with any questions you may have, to our office about 10 minutes prior to your scheduled appointment.

Notice of Privacy Practices
Acknowledgement of Receipt of Notice of Privacy Practices
Consent for and Emergency Care Information
Insurance Authorization and Reimbursement Agreement
Client Profile Information
Service Agreement
Mimosa Christian Counseling Fund Scholarship Application