Dorothy Hughes Indianapolis Counselor

Dorothy Hughes, LMHC
phone: 765-237-7652

Contact me to schedule
an appointment.



Dorothy Hughes Indianapolis Counselor

Dorothy Hughes

 

Forms

During your first session we will spend some time getting to know each other, discussing what brought you to counseling and what you hope to get out of it, as well as reviewing the intake documents. When the session is over, we should both have an idea of work we will do at future appointments, as well as a confirmation that our counseling relationship is a good fit.

Just as in any other medical provider’s practice, there are forms to be completed prior to the first session. Forms required will vary depending on whether you will be seen in the office or via telehealth.

  All Clients:  Read Notice of Privacy Practices.

  Office Appointments:
  Please complete, print, sign and bring to your first office appointment:
    Notice of Privacy Practices Acknowledgement    
    Intake Form    
    Consent for Office Appointments    
    Informed Consent    
    Realease of Information    
    Social Media Policy    

  Telehealth clients:
  Please complete and email the following documents to Dorothy at djhugheslmhc@yahoo.com. Questions about how to complete the forms and how to email them to Dorothy can be answered .    
    Notice of Privacy Practices Acknowledgement    
    Intake Form    
    Informed Consent    
    Realease of Information    
    Social Media Policy    
    Telemental Health Consent    
         
    Include in your email:    
  • A copy of your driver’s license
  • The name, address and phone number of your preferred hospital in an emergency
  • The name, address and phone number of your preferred ambulance in an emergency
    Upon receipt of all the completed documents and information above, Dorothy will contact you to schedule your first telehealth appointment which will use the HIPAA approved platform  

  Reiki clients:
  Please complete the following documents:
    Notice of Privacy Practices Acknowledgement    
    Reiki Client Information    
    Consent for Office Appointments    

  Community Health Network EAP Clients:
  In addition to the office or telehealth forms listed above are two additional forms:
    Notice of Privacy Practices Acknowledgement    
    CHN Notice of Privacy Practices (please read only)    
    CHN Permission for Counseling/Notice of Privacy Practices (print and sign)