Adult/Adolescent Substance Abuse Program

Wilson Counseling

FORMS

Our forms are fillable pdf's.  You can complete them online, or you can print them and email/scan them back to us.  You can also ask that we mail the forms to you.  We know technology can be challenging, so there are instructions that may help.  If you have any problems, we are glad to help!  

Fill and Sign

Instructions




This group of forms is information about you and has consent forms that MUST be received before you can have your first session.  All clients must complete this group of forms.

INTAKE FORM

Telehealth

Consent

Client Rights

& Responsibilities

Fee Schedule

Insurance

Form

Credit/Debit Card Authorization

Notice of Confidentiality

Acknowledgements

READ ONLY

Privacy & Practice Policies





The next section of forms are just for DUI clients.  These forms are required by the State of Kentucky and we must have each of these completed and signed.  The Recommendation Agreement will be completed after your assessment as recommendations are based on information obtained during the assessment.

Authorization

Court

Authorization

DBHDID

Authorization

DOT

Confirm &

Accept

Recommendation

Agreement

AFTER
ASSESSMENT

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