Jennifer Worcester, M.A., LPC

Forms

Online Pre-Registration 

 

After you complete the online registration please also complete the forms below, you can email them to Jennifer before your appointment or bring completed to your first appointment. 

Choose one of the following

Client Information - Adult

Client Information - Child/Adolescent

Client Information - Couples/Family

Complete all 

Jennifer's Disclosure Statement

HIPAA Document

Consent to Communicate PHI Electronically

Credit Card Authorization

Complete if you would like me to speak to another professional (Physician, Teacher, Etc.)

Release of Information