Forms 

If you are new to Virginia Counseling Associates, please complete the forms listed below and bring them your first appointment.

 

  • Outpatient Intake Form

 

  • Notice of Privacy Practices Acknowledgement

 

   Click here to read our Notice of Privacy Practices

 

  • Insurance Release and Financial Policy

 

  • Missed  Appointments Policy

 

In the event that we need to work with another clinician/provider to coordinate your and your family's care, you will need to authorize us to disclose your information by completing the release form below.

 

  • Disclosure Authorization Form

Virginia Counseling Associates | Southside Richmond: 1909 Huguenot Road, Suite 202, Bon Air, VA 23235 

Call (804)350-7952

Copyright 2019 Virginia Counseling Associates, LLC