Request an Appointment
Phone: 817-500-4188
Email: Jim.Blue@charter.net

Dr. Jim Blue

  • Home
  • About
    • Background
    • Training
    • Other Interests
  • Services
    • COVID-19 Update
    • Counseling
    • Psychological Assessment
    • New Client Forms
    • Fees
  • Personal Development Tools
    • Spiritual Health
    • Psychological Health
    • Physical Health
  • Psychology Resources
    • Books
    • Web Resources
  • Blog
  • Contact

New Client Forms

All new clients can read/download/print the following forms to fill out prior to your initial appointment with Dr. Blue.  You may then email them back to Dr. Blue at Jim.Blue@Charter.net, or simply bring them with you on the day of your appointment.

 

1.) The HIPAA Notice and the Treatment Plan are for your information, and are yours to read and keep.  You may print them or simply read them online.

HIPAA Notice. Dr Jim Blue 2018

Treatment Agreement. Dr Jim Blue 2021

 

2.) The next two documents are signature pages, acknowledging you have read the HIPAA Notice and the Treatment Agreement.  These two forms need to be printed, signed, and returned to Dr. Blue to keep on file.

Client Profile. Dr Jim Blue 2018

HIPAA Acknowledgment of Receipt Notice – Dr. Blue Feb 2018

 

3.) The next form is for detailing your current concerns and a bit of your life history.

History & Assessment – (Adult)

 

4.) If you will be paying by credit card, please print out and complete the form below and return it to Dr. Blue. Your card will be kept on file for future payments, and can be discontinued by you at any time.

CC Agreement. Dr Jim Blue 2018

  • Facebook
  • Twitter

Follow Dr. Blue on Facebook!

Jim Blue

Follow Dr. Blue on Twitter!

Tweets by DrJimBlue

Recent Posts

  • Past, Future, or Present?
  • Live your dream – do not die with your music still inside of you!
  • Live in the Here and Now!
  • We will all die one day!! Until then, we should LIVE FULLY!
  • Hello world!

Categories

  • Personal Development
  • Psychology Articles
  • Spiritual Growth
  • Uncategorized

Looking For Something?

Lets Make A Connection

  • Facebook
  • Twitter

Tags

create a better you Dead Poet's Society Dr. Jim Blue Eric Bourassa follow your dreams guitar Jimi Hendrix let go of fear and worry live fully live in the here and now live in the present moment Live your dreams living in the past personal development present to the moment spiritual growth Thoreau we will all die worry about the future

Pages

  • Home
  • About
    • Background
    • Training
    • Other Interests
  • Services
    • COVID-19 Update
    • Counseling
    • Psychological Assessment
    • New Client Forms
    • Fees
  • Personal Development Tools
    • Spiritual Health
    • Psychological Health
    • Physical Health
  • Psychology Resources
    • Books
    • Web Resources
  • Blog
  • Contact

Find My Office

6420 SW. Blvd., Suite 115
Fort Worth, TX 76109

Emergency??

If you are contemplating suicide or are in acute crisis, please call 911 or the National Suicide Prevention Lifeline: 1.800.273.TALK (8255). This is a free, 24-hour hotline available to anyone in suicidal crisis or emotional distress. Texas Child Abuse Hotline 1-800-252-5400

Privacy Policy

A bright site by Brighter Vision