[et_pb_section fb_built=”1″ _builder_version=”4.16″ min_height=”39px” custom_padding=”34px|0px|11px|0px|false|false” da_disable_devices=”off|off|off” global_colors_info=”{}” da_is_popup=”off” da_exit_intent=”off” da_has_close=”on” da_alt_close=”off” da_dark_close=”off” da_not_modal=”on” da_is_singular=”off” da_with_loader=”off” da_has_shadow=”on”][et_pb_row _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” custom_margin=”|||” custom_padding=”10px||0px|” border_color_all=”rgba(51,51,51,0.5)” border_width_top=”1px” border_color_top=”rgba(102,102,102,0.5)” border_width_bottom=”1px” border_color_bottom=”rgba(102,102,102,0.5)” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.16″ text_font=”Arial|||on|||||” header_font=”|||on|||||” header_font_size=”18px” header_2_font=”|700|||||||” global_colors_info=”{}”]<\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.16″ da_disable_devices=”off|off|off” global_colors_info=”{}” da_is_popup=”off” da_exit_intent=”off” da_has_close=”on” da_alt_close=”off” da_dark_close=”off” da_not_modal=”on” da_is_singular=”off” da_with_loader=”off” da_has_shadow=”on”][et_pb_row column_structure=”1_4,1_4,1_4,1_4″ _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” global_colors_info=”{}”][et_pb_column type=”1_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_blurb title=”Intake Form” url=”https:\/\/gahannacounseling.local\/wp-content\/uploads\/2018\/06\/Intake_Form.pdf” url_new_window=”on” use_icon=”on” font_icon=”||divi||400″ _builder_version=”4.16″ header_level=”h3″ header_font=”||||||||” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n
Please follow the instructions to complete this form prior to attending your first appointment.\u00a0 If you are unfamiliar with your insurance benefits, please contact your insurance company to learn about your coverage.<\/p>\n
Download the Intake Form (PDF)<\/a><\/p>\n [\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_blurb title=”Privacy Practices” url=”https:\/\/gahannacounseling.local\/wp-content\/uploads\/2018\/06\/Privacy_Practices.pdf” url_new_window=”on” use_icon=”on” font_icon=”||divi||400″ icon_color=”#e5b80e” _builder_version=”4.16″ header_level=”h3″ header_font=”||||||||” global_colors_info=”{}”]<\/p>\n This is a description of how your Protected Health Information (PHI) is used at our office.<\/span><\/p>\n Download Privacy Practices (PDF)<\/a><\/p>\n [\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_blurb title=”Informed Consent” url=”https:\/\/gahannacounseling.local\/wp-content\/uploads\/2018\/06\/Informed_Consent.pdf” url_new_window=”on” use_icon=”on” font_icon=”||divi||400″ icon_color=”#666666″ _builder_version=”4.16″ header_level=”h3″ header_font=”||||||||” global_colors_info=”{}”]<\/p>\n This form describes your therapeutic relationship with Gahanna Counseling, LLC.\u00a0 Please read this form carefully and discuss any questions with your therapist. Your signature is required on the last page.<\/p>\n Download the Informed Consent (PDF)<\/a><\/p>\n<\/div>\n<\/div>\n [\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_blurb title=”Telehealth Informed Consent” url=”https:\/\/gahannacounseling.local\/wp-content\/uploads\/2022\/04\/Informed-Consent-Telehealth-Mar-20.pdf” url_new_window=”on” use_icon=”on” font_icon=”||divi||400″ icon_color=”#9D038F” _builder_version=”4.17.1″ header_level=”h3″ header_font=”||||||||” global_colors_info=”{}”]<\/p>\n This form describes the use of telehealth, electronic service delivery, and technology-assisted approaches in your therapeutic relationship with Gahanna Counseling, LLC.\u00a0 Please read this form carefully and discuss any questions with your therapist. Your signature is required on the last page.<\/p>\n