Keep Moving Forward Counseling & Consulting LLC

Intake Forms

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While we try to keep our forms to a minimum, for your convenience, here are our standard forms that you might find helpful to review before, rather than during your first appointment.    
 Informed Consent   
informedconsent_2-23-2019.pdf
File Size: 136 kb
File Type: pdf
Download File

 HIPPA Privacy Practices
hippanoticeofprivacypractice.pdf
File Size: 112 kb
File Type: pdf
Download File

Client Rights
hipaaclientrights.pdf
File Size: 36 kb
File Type: pdf
Download File

Fee Schedule
feeschedule02-01-2020.pdf
File Size: 118 kb
File Type: pdf
Download File

Consent Relationship Counseling

informedconsent_marriage-couples_counseling08-18-2019.pdf
File Size: 120 kb
File Type: pdf
Download File

​INSURANCE   Our in network contracts include Anthem, Med Mutual, Cigna, CareSource, Medicaid, Buckeye, and Medicare*.  Other insurance plans are accepted on an out-of-network basis.   We also accept self-pay.  Our fee schedule can be found on the Intake Forms page.   (*Medicare insurance holders may be limited to those clinicians that are eligible to bill Medicare.  Please ask before scheduling an appointment if your therapist is credentialed with your insurance.)
Photo used under Creative Commons from jon_a_ross
  • Home
  • Meet the Therapists
  • Appointment or Consultation Request
  • Forward Thinking
  • Services
  • Vision & Philosophy
  • Contact
  • Privacy Policy
  • Intake Forms
  • Relationship Counseling
  • Feedback