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Aya Psychological and Wellness Services, LLC

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Restoring Balance Resilience and Resourcefulness

Providing Consistently Compassionate Therapy Services

in the State of Florida since 2018.

Forms

BEFORE WE MEET:

Please review the following forms prior to our first meeting. You may print them out or download them.

HIPAA NOTICE OF PRIVACY PRACTICES (PDF)

OFFICE AND PRACTICE POLICIES (PDF)

GETTING READY FOR YOUR FIRST SESSION:

Complete the following consent forms prior to attending your scheduled for an intake appointment.

CONSENT TO TREATMENT/ ACKNOWLEDGEMENT OF OFFICE POLICIES FORM (PDF)

ONCE WE START WORKING TOGETHER:

RELEASE OF INFORMATION

Collateral Consent Form

* Used if you you'd like someone important to participate on a limited time basis in your therapy journey

DURING THE THERAPY PROCESS:

CLIENT OUTCOME QUESTIONNAIRE

THOUGHT RECORD

Forms and formatting of this page are gratefully adopted, modified, and used
with permission from Dr. Keely Kolmes, Psy.D, Psychologist.

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