Intake Consents

Before the Scheduling Team books the Intake appointment in TN, the Intake Packet (Example Intake Packet.pdf) must be collected. In most cases, a client will NOT be scheduled for an Intake without a completed Intake Packet.  The Scheduling Team is responsible for collecting the Intake Packet.  The following documents/consents are found within the Intake Packet.

Intake Packet includes the following:

1. Booking Information
2. Demographics/Questionnaire/History
3. Parent/Guardian Information (for minors 17 and under)
   1. Consent to Treat Minor
   2. Consent for Divorced Parents
4. Attendees' Info (for couples/family counseling)
   1. ROI for spouse/family member.  The ROI within the Intake Packet allows us to share information about the client with the other attendees mentioned.  There is no need to send additional ROIs for each attendee.
5. Insurance Information
   1. Medicaid Rights and Responsibilities
   2. Private Pay Agreement
   3. Cancelation policy
6. HIPAA Notice of Privacy
7. Telehealth Informed Consent
8. Consent to Use AI Scribe During Session

Minor consents

If the client is a minor (17 and under), the first Consent to Treat Minor form is in the Intake Packet.  If the minor has divorced parents who have 50/50 custody, then the second parent must also consent.  

Couples consents

If the Intake appointment is a couple counseling intake, all adult members need to sign an ROI.  

Family consents

If the Intake appointment is a family counseling intake appointment, all adult members need to sign an ROI.  

Transfer Client consents

When a client is transferred internally, the following consents are sent to the client by the Scheduling Team:

1. Authorization for Collaboration (if multiple providers are accessing the same client file in TN)
2. Provider About Me

The Clinician's responsibility

Clinicians MUST get the Disclosure Statement and About Me signed after the Intake appointment.