Please print and complete the Registration, HIPAA Privacy Notice and Release of Information forms below to bring with you to the first appointment.
The administrator will need these forms to register you in the Macks Psychology Group System.
After scheduling your initial appointment you will be emailed a link to the secure client portal where you can complete most consents and agreements online. This secure client portal helps us get started by making it easier for you to review practice policies/consents and provide some basic information before our first session. Completing the paperwork prior to our appointment will allow us to spend the time together discussing your treatment needs rather than filling out paperwork.
If you prefer to download and sign forms rather than using the client portal you may do so. All paperwork needs completed for a Diagnostic Evaluation. If scheduling a consultation consult with your provider regarding which forms are needed. Please bring the completed forms to your diagnostic evaluation appointment.
The documents below are specific to meeting with Christy Pulsford MSW, LISW-S, LICDC and not all Macks Psychology Group clinicians. MPG forms are above and will also need to be completed to register you with Macks Psychology Group.
Please be aware that Christy Pulsford uses telehealth including but not limited to phone, email and text. By scheduling an appointment, using the client portal or contacting Christy Pulsford you consent to receiving information from Macks Psychology Group and GrowthINsight Counseling LLC via email, phone and text. This includes but isn't limited to email replies, appointment reminders, scheduling instructions and delivery of forms and consents.
Christy Pulsford, MSW, LISW-S, LICDC
8050 Beckett Center Dr. Suite 314 West Chester, Ohio 45069
Phone: (513) 847-3891
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