Client Intake Form
This form must be completed before we can treat or will agree to treat you. Please print, fill out the document and bring it fully completed to your first session. This will save you time and money.
Client Reduced Fee Form
This form must be completed to apply for reduced fees
Therapy Agreement Form
Before we are allowed to treat you, this form must be read and acknowledged by you. It includes important information about your treatment and our expectations of you. It also includes a HIPAA Form that discusses your rights of privacy. Please print an extra copy of this for your records and bring both copies to your first session.
Client Feedback Form
We would like to invite your feedback from your session today. We will review your feedback free of charge as a part of your session today. This will allow you to assess your own inner impressions and will allow us to provide you with the best service possible in the future. You may fill this out on-line and e-mail it to mailto:innerspectrums@gmail.com or print and bring it in with you to your next session. * IMPORTANT: Make sure you save the file before you print or submit it by e-mail.
First Session:
Save yourself money by printing and bringing a copy of the following forms to your first session: We must have copies of these forms signed before we will be able to treat you. If they are filled out prior to the appointment you won't have to pay to do so.
Therapy Agreement Form
Client Intake Form
Client Reduced Fee Form
Client Feedback Form (Please e-mail to innerspectrums@gmail.com) after each session. THANKS!
PLEASE NOTE: Forms may occasionally change. Please send all documents to the addresses or e-mail provided on this page. Do not refer to the addresses listed on the linked forms as they may have changed. Addresses, phone numbers and Fax that are listed on this page are current.
Inner Spectrums, Inc.
Cheryl E. Haws MSW, MCHt., LCSW, ABD
Shelly A. Eyre MSW, LCSW, OSW-C
Licensed Clinical Social Workers in the State of Utah
Business Consultant, Psychotherapists, Energy Psychology, Intuitive Counseling
3051 Maple Loop Drive Suite 201
Lehi, UT 84043
Fax # (866) 630-9306
Phone: (801) 400- 5096
Mobile (801) 636-6609
innerspectrums@gmail.com
www.innerspectrums.com