Click here for Initial Paperwork packet!

Faithful Counseling and Therapy Services, LLC

Faithful Counseling and Therapy Services, LLCFaithful Counseling and Therapy Services, LLCFaithful Counseling and Therapy Services, LLC
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  • Services
  • General information
  • Initial visit information
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    • Home
    • Services
    • General information
    • Initial visit information

Faithful Counseling and Therapy Services, LLC

Faithful Counseling and Therapy Services, LLCFaithful Counseling and Therapy Services, LLCFaithful Counseling and Therapy Services, LLC
  • Home
  • Services
  • General information
  • Initial visit information

Initial paperwork due prior to first visit

Download our forms and return them below before your appointment.

INTAKE PACKET:

1. Patient Information

2. Informed Consent

3. HIPAA notification 

4. Verification of Benefits (to be filled out when verifying benefits with insurance company)

Faithful Counseling and Therapy Services, LLC Initial Paperwork (pdf)Download

Verify your insurance benefits

Please contact your insurance company prior to your first visit to ensure a full understanding of charges that will be incurred with services.  


A Verification of Benefits form is part of the initial paperwork packet. Fill that out prior to calling your insurance for an efficient experience.  Please return completed form to your provider. 


Provider information :

Debbie D. Sardina

NPI  1770697716


LMHC 39003185A (Indiana)

LCPC 180.005715 (Illinois)

LMHC 61537102 (Washington) 



PAPERWORK DUE AT FIRST VISIT

ADULT ASSESSMENT FORM

Files coming soon.

PAPERWORK DUE AT FIRST VISIT

ADOLESCENT  ASSESSMENT FORM


Files coming soon.

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