GrowthINsight Counseling 
513-8473891
GrowthINsight Counseling 
513-8473891
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  • Telehealth
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  • Clinical Counseling
  • Attention/Accountability
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  • College/Young Adult
  • Families & Relationships
  • Insurance Questions
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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 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.


You may print and sign forms rather than use the client portal. 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. 

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

Please contact your provider for treatment consent forms specific to insurance and EAP billing. A sample form can be found on the Insurance Questions page of this website.

(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 © 2023 GrowthINsight Counseling LLC - All Rights Reserved

(513) 847-3891