GrowthINsight Counseling 
513-8473891
GrowthINsight Counseling 
513-8473891
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    • Home
    • Services
    • Scheduling
    • Rates
    • Forms
    • Resources
    • Client Portal
    • Telehealth
    • Growth & Wellness
    • Gifted Youth & Adults
    • College/Young Adult
    • Families & Relationships
    • Gifted FAQ
    • Insurance Questions
    • Training Supervision
  • Home
  • Services
  • Scheduling
  • Rates
  • Forms
  • Resources
  • Client Portal
  • Telehealth
  • Growth & Wellness
  • Gifted Youth & Adults
  • College/Young Adult
  • Families & Relationships
  • Gifted FAQ
  • Insurance Questions
  • Training Supervision

Forms, Polices and Consents

Policies and Consents for your review


 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 letting you review practice policies/consents and provide some basic information. Completing the paperwork before the appointment will allow us to spend the time together discussing your treatment needs rather than filling out forms. Below are copies of the documents in pdf format for your reference and review.


If you prefer to print and sign forms rather than using the client portal, you may do so. If choosing this option, please bring the completed forms to your appointment. Only sign forms that you understand. If you have questions or concerns about any paperwork, please discuss them with your clinician.

Policies and Consents

Consultation Appointment

Psychotherapy & Clinical Counseling Appointment

Diagnostic Evaluation Appointment

forms

Diagnostic Evaluation Appointment

Psychotherapy & Clinical Counseling Appointment

Diagnostic Evaluation Appointment

forms

Psychotherapy & Clinical Counseling Appointment

Psychotherapy & Clinical Counseling Appointment

Psychotherapy & Clinical Counseling Appointment

forms

Consultation Appointment

 If you prefer to print and sign forms rather than using the client portal you may do so. If choosing this option, please bring the completed forms to your appointment. 


The forms below are for CONSULTATION appointments.

HIPAA Notice and Acknowledgement of Privacy Practices (pdf)Download
Consent for Telehealth (pdf)Download
Consent for Consultation (pdf)Download

Policies and Consents for Treatment

If you prefer to print and sign forms rather than using the client portal you may do so. If choosing this option, please bring the completed forms to your appointment.


Forms below are for DIAGNOSTIC EVALUATIONS, PSYCHOTHERAPY, CLINICAL COUNSELING, and EAP appointments. 


NOTICE of CHANGE in FEES effective 06/01/2022*

Practice Policies (pdf)Download
Consent for Telehealth (pdf)Download
HIPAA Notice and Acknowledgement of Privacy Practices (pdf)Download
Informed Consent for Treatment (pdf)Download
Registration Form (pdf)Download
Consent to Authorize the Release of Information (pdf)Download
Consent to Treat a Minor (pdf)Download
Informed Consent for Treatment under insurance benefits (pdf)Download
Informed Consent for Treatment under EAP benefits (pdf)Download

*Change in fees effective 6/01/2022

This serves as notice that fees for services at GrowthINsight Counseling LLC will change. 

New rates will take effect on 6/1/2022. 


Current rates will be honored for the remainder of 2022 for established clients who remain active in treatment. The expected fee change will take effect for established clients on 01/01/2023. Established patients who do not attend treatment for 90 days are no longer considered active and will be subject to the new rates upon re-engaging in treatment. Please reference the appropriate informed consent for treatment form above for the new fees for services.

(513) 847-3891

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 receive information from Christy Pulsford 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.      


  Appointments are not for crisis care.

If you are experiencing a mental health crisis and need immediate assistance 

CALL 911 or go to the nearest emergency room. 

request an appointment
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Christy Pulsford, MSW, LISW-S, LICDC

8050 Beckett Center Dr. | West Chester, Ohio 45069

Phone: (513) 847-3891

Copyright © 2022 GrowthINsight Counseling LLC - All Rights Reserved

(513) 847-3891