(801) 910-3880
hellobalanceconnection@gmail.com
95 West 100 South, Suite 330 Logan, UT 84321

Balance Connection

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Client Forms

If you are new, please be sure to fill out the following forms, and bring them to your first session. This will help ease you in and allow as much time as possible to focus on you.

Intake Information

Cancellation

Electronic Payment Authorization

HIPPA Notice of Private Practices

Limits of Confidentiality

Professional Service Agreement

Authorization for Mental Health Care

Restraint Agreement

Insurance Information

Balance Connection


(801) 910-3880

hellobalanceconnection@gmail.com

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95 West 100 South, Suite 330
Logan, UT 84321

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