FORMS

Our intake forms and online paperwork takes most clients about 30 minutes to read and fill out, so we recommend completing them prior to your visit. If you cannot complete them prior to your first session, please come early to allow enough time to finish them before your intake. 


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We do require you to complete your intake questionnaires in our patient portal which can be found here: Eclipse Counseling Patient Portal. If you do not have an opportunity to complete your paperwork and online forms, we will spend time during your intake session to do so. If you need help setting up your portal please call us at 715-255-1117. Thank you!

NOTICE OF HIPAA PRIVACY PRACTICES

This notice describes how medical information about you may be used or disclosed and how you can get access to this information. Please review it carefully. A signed copy needs to be returned to the clinic before an initial appointment can be scheduled. This paperwork is required.

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This can be faxed back at 320-640-9261 or emailed to info@eclipsecounselingcenter.com

CLINIC INFORMATION & POLICY FORM

This paperwork is required to be filled out, reviewed, and signed prior in order to be scheduled your first appointment.

This can be faxed back at 320-640-9261 or emailed to info@eclipsecounselingcenter.com

CLIENT RIGHTS & GRIEVANCE PROCEDURE

This is a brochure about Client's Rights and filing a grievance.

BILL OF RIGHTS FOR CHILDREN & ADOLESCENTS

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This is a brochure about rights as a minor for outpatient mental health treatment.

PARENTAL AGREEMENT

This form only needs to be completed if the client is a child or adolescent and their custodial parents, legal guardians and/or caregivers are divorced or not cohabiting.

RELEASE OF INFORMATION

Completing this form allows your therapist to coordinate care with anyone outside of the therapy office (e.g., doctors, teachers, lawyers, social workers, etc.)

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Note: a separate release of information must be made for each individual or entity.