480-498-7600
mandy@compassionatepathways.us
Schedule an Appointment

Compassionate Pathways Counseling

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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.

HIPAA

All new clients please complete the following:

Intake Form

If you are using insurance to pay for services, please fill out the following form:

Insurance Release

If you would like to place a credit card on file for automatic payment, please use the following form:

Credit Card Authorization

If someone else is paying for your therapy (parent, bishop, family member, etc.) you both will need to complete the following:

Third Party Payer

If you feel that you would like to collaborate your session with another provider or individual, if you would like another individual to attend your session, all couples should also complete this form releasing me to speak to their partner, please use the following form:

Release of Info

 

Mandy Schulzke

Compassionate Pathways Counseling

480-498-7600
mandy@compassionatepathways.us

17505 N 79th Ave Suite 213
Glendale, AZ 85308

Mandy Schulzke

Compassionate Pathways Counseling

480-498-7600
mandy@compassionatepathways.us

17505 N 79th Ave Suite 213
Glendale, AZ 85308

Find My Office

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