This document thoroughly describes the counseling process and other policies of Nate Marshall Counseling, PLLC. If submitting this form electronically, all fields must be completed. If you are printing this out and completing it by hand, you will need to write your name on the top of each page and initial the bottom of each page, which indicates that you have read the information contained on that page. In the middle of page 4, there is a spot that requires another initial, indicating that you have been given access to the HIPAA Notice of Privacy Practices Statement (available below). Towards the top of page 7, there are three sections to initial to ensure that you have reviewed these particular policies, as they are very important. Towards the bottom of page 7 your signature, printed name, and date are required. FInally, page 8 is an overview of the fee schedule for different services offered through Nate Marshall Counseling, PLLC. On the bottom of this page is the final place where you will need to sign, print your name and provide the date.
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