Forms

We invite you to register for further information on the many ways YOU can improve the quality of your life!

Please sign up for the services you are interested in, and we will contact you shortly to verify your registration and confirm your interest in our services.

You may be removed from our contact list at any time; please just get in touch with us (via email, mail, or phone!) to let us know your preference.

Register for more information


Intake Form

For your convenience, you can download and fill out the Intake Form and just bring it with you to the office.

Just click on the link above to open the PDF form, fill it out on your computer, then print and sign it! (You can also just print the form and fill it out by hand, if you prefer.)

Confidentiality Form

For your convenience, you can download and fill out the Confidentiality Form and just bring it with you to the office.

Just click on the link above to open the PDF form, fill it out on your computer, then print and sign it! (You can also just print the form and fill it out by hand, if you prefer.)

HIPAA Authorization

For your convenience, you can download and fill out the HIPAA Authorization Form and just bring it with you to the office.

Just click on the link above to open the PDF form, then just print and fill out the form!

Cancellation Policy

If you fail to cancel a scheduled appointment, you will be billed for the entire cost of your missed appointment ($180.00).  You are paying us for our time, and we could use this hour to schedule another client.

A full fee is charged for missed appointments or no show cancellations with less than a 48 hour notice unless due to series illness or an emergency. You credit card will be charged for the hour.

Thank you for your consideration regarding this important matter.

Please take a moment to click on the Cancellation Policy form above, print, and sign it to bring with you to the office.

Procedure for Records/Information 

We are a marriage and family counseling practice. Records may be intertwined, and confidentiality is handled differently including signatures.    This is the process for gaining a copy of records:

A client needs to come in with proper identification and sign a release. 

  • The release is to clarify what information is to be released and, in the case of marriage or family counseling, where other individuals have been seen and records are intertwined, those individuals also need to sign releases.
  • If an individual is 18 years old or older, they need to sign the release.
  • We ask you comply to our office policy for releasing information. The information needs to be managed carefully since spouses or other family members have attempted to get records for custody, etc. by means of random faxes, letters, and phone calls. Those who want their records release must come to our office, have the appropriate identification, and clarify what is to be released.
  • Client records are different than psychotherapy notes.

 We do not respond to random emails or faxes since we have no clue who is sending or making the request. 

When appropriate we charge a fee for our time and supplies. 

 According to HIPAA guidelines, mental health professionals can decide whether to release their psychotherapy notes to patients, unless patients would have access to their psychotherapy notes under state laws. Though the privacy rule does afford patients the right to access and inspect their health records, psychotherapy notes are treated differently. Patients do not have the right to obtain a copy of these under HIPAA. In addition, if a clinician denies a patient access to psychotherapy notes, the denial isn't subject to a review process, as it is with other records.   


Contact Me

1111 N Westshore Blvd. Suite 213

Carter and Evans Marriage & Family Therapy

Availability

Carter & Evans Marriage Family Therapy

Monday:

9:00 am-6:00 pm

Tuesday:

9:00 am-6:00 pm

Wednesday:

9:00 am-6:00 pm

Thursday:

9:00 am-6:00 pm

Friday:

9:00 am-6:00 pm

Saturday:

Closed

Sunday:

Closed