JANE MCCAMPBELL, MARRIAGE COUNSELOR: PAPERWORK PAGE
New Clients
Please complete the following THREE forms and bring them with you to your first session:
Please also familiarize yourself with the Notice of Privacy Practices as you will need to sign a form stating you have read it and consent to it. If you will be requesting a Sliding Scale discount, your signature on the above documents will indicate your agreement to abide by the Sliding Scale Policy.
Couples therapy:
BOTH OF YOU should complete a set of paperwork.
Can't print?
Let Jane know and she will leave a clipboard in the waiting room for you. You will need to arrive approximately 15 minutes early.
Cold feet?
Attending therapy for the first time can be anxiety-provoking. Couples in particular frequently fail to show for their first appointment. Jane understands that anxiety and avoidance are a natural part of the process, but asks that you please be respectful of her schedule by letting her know a minimum of 24 hours in advance of your appointment time if you are not intending to show. You can do this by voicemail on 612 414 0383 or click here to send a message through this website.
EMDR Paperwork
The following paperwork is required for clients undertaking EMDR therapy:
The Dissociative Experiences Scale (DES) was developed by Eve Bernstein Carlson, Ph.D. and Frank W. Putnam, M.D. This copy was purchased from the Sidran Institute and is provided here for clients of Jane McCampbell to complete as part of their preparation for EMDR therapy. It is not intented for general download or for publication on other websites. If you require a copy for such purposes, please contact the Sidran Institute directly.
Questions?
If you have any questions as you are filling out these forms, please note them down so that you remember to ask Jane when you come for your first session. You can always leave a question blank or a document unsigned until you have the opportunity to ask for more information.
© 2012, Jane McCampbell, MA, LMFT
EMDRIA-Certified EMDR Therapist
Liciensed Marriage & Family Therapist
Jane McCampbell Counseling Services, LLC
Minneapolis Saint Paul, MN
Jane McCampbell Counseling Services, LLC Baker Court, 821 Raymond Avenue, Suite 325, St Paul, MN 55114 Tel: 612 414 0383
