North Central Client Forms

AUTHORIZATION TO DISCLOSE FORM - English

AUTHORIZATION TO DISCLOSE FORM  - Spanish

INDIVIDUAL RIGHTS & RESPONSIBILITIES

NOTICE OF PRIVACY PRACTICES

Health Directions Appointment Information & Forms

In-Person Appointment Guidelines

• Your Clinician will either greet you at the Health Directions entrance or in the waiting room* at your scheduled appointment time.

• The entrance to Health Directions along with reserved parking, is located in the back of the NCBHS, Inc. building and is available for those receiving services at Health Directions.

• The Health Directions door will remain unlocked at all times, therefore, if you are to arrive early to your scheduled appointment, please wait in the waiting room* located to the left of the Health Directions back entrance.

• Please complete and review the following information/forms and bring them to your first appointment:

1. Authorization for Treatment Form
2. Authorization to Disclose Form
3. Individual Information Form
4. Privacy Practices
5. Privacy Practices (Spanish Version)
6. Privacy Practices Acknowledgment Form

• Payment is expected at the time of your service and it will be your responsibility to complete any necessary pre-authorization with your insurance company.

• You will be charged for any session that is not cancelled within 24 hours of your scheduled appointment.

 *The LaSalle office is the only location with a Health Directions waiting room.  At all other locations, your clinician will greet you at the Health Directions entrance at your scheduled appointment time.