Forms

If you're a new counseling client, please complete the following forms and bring them to your first therapy session.


It is not necessary to print out the HIPAA Notice of Privacy Policies. Here is the link to this document for your review.

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), or speak to a friend or family member about your care, complete this form for each individual you want me to contact to authorize release of psychotherapy information:


Note: To download Adobe Acrobat Reader for free, click here.


Jennifer Hume, LMHC, LPC, MCAP
561-951-0879

North Palm Beach Office:

840 U.S. Highway 1
Suite 435
North Palm Beach, FL 33408

[email protected]