Please print and complete the applicable forms below before your appointment with Dr. Vick or arrive 30-minutes prior to your first meeting to allow time to complete the new client registration packet.  

In addition, be sure to bring the following items to your appointment:  (1.) Driver's license or ID card  (2.) Insurance Card (3.) prior (psychological, psychiatric, educational, and other applicable treatment records), and (4.) contact information of all your treatment providers.

THERAPY CLIENTS    
(DOWNLOAD  & COMPLETE ALL 6 FORMS)

(1.)  Service Agreement
2.)  Credit Card Authorization Form
(3.) HIPAA policy 
(4.) Missed Appointment Policy
(5.) Paperwork Policy
(6.) Electronic & Social Media Policy

AND EITHER 

(8.)  Adult History Form 
(9.)  Child  History  Form


​PARENTING COORDINATION FORMS
(DOWNLOAD & COMPLETE ALL FORMS)

(1.) Cover Letter 
(2.) Intake Form
(3) PC Service Agreement
(4.) Release of Information Form
(5.) PC Screening  Questionnaire
(6.) Explanation of PC Fees-Rule 15
(7.) Credit Card Authorization Form

CO-PARENTING DIVORCE COACHING FORMS
(DOWNLOAD & COMPLETE ALL FORMS)

(1.) Cover Letter 
(2.) Intake Form 
(3.) Coaching Service Agreement
(4.) Release of Information Form
(5.) Coaching Screening Questionnaire
(6.) Credit Card Authorization Form

1463 Oakfield Drive,  Suite 136, Brandon, FL 33511
(813) 689-2525 (phone)
(813) 689-4433 (fax)
drgvick@gmail.com 

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