Client Forms

In order to gain a better understanding of each client’s personal information, family background, medical history, and current areas of struggle, we ask that you complete each of the forms below so that we can create your customized treatment plan. The forms also include a consent form, payment information, and release authorization.

To submit the forms below, you MUST first download and save them to your computer. They cannot be filled out directly online. Once they are saved in your preferred location on your computer, open each file and begin typing to fill in all necessary boxes of the form. After you have filled out each form, save the completed forms to your computer and send them to your assigned therapist.

We value the privacy of each client, and we ensure that all data will be kept confidential. Thank you and please contact us with further questions.

Authorization For Release

Good Faith Estimate Notice

GROUP Therapy Policy, Agreement & Consent

Biographical Data

Health Questionnaire

Therapy Consent, Policies, & Agreement

Credit Card on File Agreement

HIPPA Form

Privacy Notice

At CCAA, we are committed to maintaining the privacy and security of our patients’ personal information. This Privacy Notice outlines our practices and your choices regarding the use of your information for SMS (Short Messages Service) communications.

Opt-In: By providing your mobile number, you are opting in to receiving SMS communications from CCAA. These messages may include appointment reminders, health tips, and other relevant updates. Your mobile number will be used for healthcare-related communication and will not be shared with third parties for marketing purposes.
Opt-Out: You may opt-out of receiving SMS communications at any time. To opt-out, reply ‘STOP’ to any message you receive from us or contact our office directly. Once you opt-out, you will no longer receive SMS communications from us. Please note that opting out will not affect other forms of communication such as emails or phone calls.
Fees: While CCAA does not charge for SMS communications, standard message and data rates may apply depending on your wireless carrier and plan.
Privacy: We respect your privacy and are committed to protecting your information. All SMS communications are compliant with the Health Insurance Portability and Accountability Act (HIPAA), which protects your health information from unauthorized use or disclosure.
Updates: We may change this Privacy Notice from time to time. Any changes will be effective immediately upon posting of the revised notice on our website.

By opting in to our SMS communications. You acknowledge and agree to the practices outlined in this Privacy Notice. If you have any questions, please contact our office at: contact@compasscaa.com

Your privacy is important to us, and we are committed to providing you with the highest level of service with respecting and protecting your personal information.