Keith Miller Forms

I look forward to meeting with you very soon. Please complete the forms and bring them to the first session or take the first few minutes of your session to fill them out after I greet you in the waiting area.

NOTE ABOUT PAYMENT: Payment is expected at each session. Checks or cash are preferred. Please make checks payable to “Keith Miller Counseling, LLC.”  We also accept Visa, MasterCard, and Discover (see credit card form below).

The following two forms are REQUIRED for meeting with Keith Miller:

CLIENT_CLINICAN_AGREEMENT_FORM

Client_Data_Form_and_Consent_for_Care

 

The following forms are OPTIONAL and used only when needed

CREDIT_CARD_AUTHORIZATION_FOR_SERVICES_FORM

Consent for Release of Information