Client History Form

This form is information you complete prior to your appointment with your therapist. This is general information about your current behavioral health concerns, current health status, and other relevant information to give the therapist an idea of how to best treat you. The form is. used by the therapist during the first appointment to gather additional information.

Consent for Services

This form states that you understand you are consenting or agreeing to allow providers at Imani Behavioral Health to give you behavioral health services. The form must be signed by someone of age and legal right to consent to services for minors.

Notice of Privacy Practices

Deciding to come to therapy is a huge step. After you complete the Schedule an Appointment form, someone will reach out to you within 24 hours to schedule an appointment. This session can be booked as early as the same week.

Release of Information

This form, when properly completed, permits the release of information about a person receiving services. You are able to select the type of information released as well as specify who receives the information. The form can be withdrawn at any time with a written request.

Sliding Scale Policy

This form is for individuals who do not want to use insurance or do not have insurance and believe the self pay rates are unaffordable. The form requires information about household size and income to see if an individual qualifies for a reduced rate and the amount of the reduced rate for services.

Schedule an Appointment

Deciding to come to therapy is a huge step. After you complete the Schedule an Appointment form, someone will reach out to you within 24 hours to schedule an appointment. This session can be booked as early as the same week.