Counseling and Evaluation Program Forms

Life Happens. We’re Here to Help.

  • Substance Abuse Services (SAS)
  • Counseling Services

Please review these forms and documents in advance of your appointment. If EFR’s Intake Specialist directed you to fill out any forms, please download and fill those out in advance of your appointment. As a reminder, you may click here to access the same forms on our patient portal

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Acknowledgement of Privacy Practices

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Client Rights and Responsibilities

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Counseling and Evaluation Services Informed Consent

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EFR Notice of Privacy Practices

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Release of Information

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Counseling and Evaluation Financial Form

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Substance Abuse Services Consent to Release DOT

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Substance Abuse Services Pre-Assessment Part I

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Substance Abuse Services Pre-Assessment Part II Legal & Other Mandated Referrals

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Substance Abuse Services Mental Health Screening Form

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Substance Abuse Services Intake Survey Assessment

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Counseling and Evaluation Service Description

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Telehealth Description

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Zoom Meeting Instructions

Please review these forms and documents in advance of your appointment. If EFR’s Intake Specialist directed you to fill out any forms, please download and fill those out in advance of your appointment. As a reminder, you may click here to access the same forms on our patient portal

document (3) 1

Acknowledgement of Privacy Practices

document (3) 1

Client Rights and Responsibilities

document (3) 1

Counseling and Evaluation Services Informed Consent

document (3) 1

EFR Notice of Privacy Practices

document (3) 1

Release of Information

document (3) 1

Counseling and Evaluation Financial Form

document (3) 1

Counseling and Evaluation Services Privacy and Confidentiality

document (3) 1

Counseling and Evaluation Service Description

document (3) 1

Telehealth Description

document (3) 1

Zoom Meeting Instructions

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