Making your first appointment...

 To schedule your appointment, please contact my scheduler at: (210) 209-0642

Our aim is to return all calls regarding scheduling by end of business day or the next and during normal business hours of operation (8 am-5 pm, M-F), so please expect our call!. Please complete the following inquiry below to faster scheduling. (If this is a life-threatening emergency, call 911 or go to your hospital nearest emergency room).

Office: (210) 606-1934                                  Fax: (855) 462-9865                                 Email: Counselor@StephanieRichardsLPC.com

**For New Insurance Clients: Please email the following information before your first session so that our office can verify your benefits and inform you of your out of pocket expense for services. You may provide your insurance information in the "Contact Me" box to your left. Failure to include all the following information below may result in a delay of verification of your benefits:

  • New Client's Name (first and last, as it appears on your Insurance card)
  • New Client's Date of Birth
  • New Client's Address, City, State, ZIP (where you receive your Insurance statements)
  • New Client's Phone Number (where you can be contacted to finalize your scheduling)
  • New Client's Member ID and Group Number (located on your Insurance Card)
  • If applicable, the Primary Subscriber's Name AND Date of Birth
    Employer (if benefits are funded by an employer)
  • Behavioral Health/CD Provider phone number (800# on back of card, sometimes labeled as "Behavioral Health" or "Mental Health/Substance Abuse Percertification")

 "He heals the brokenhearted, binding up their wounds." Psalm 147:3

 

 

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New Client Forms (Bring with you to 1st session)

  • File

    ADOLESCENT NEW CLIENT FORM (Age 12 -17)

     (96K)
    Teens: This is a confidential form. This means that the information you share with your counselor is between you and your counselor, with a few exceptions. Please print and complete all of parts and bring it to your first session with your counselor. This form is used to help your counselor get to know you. You and your counselor will have time to discuss what you shared about yourself at your first session.
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    ADULT NEW CLIENT FORM (Age 18+)

     (130K)
    New Adult Clients: Please print and complete this form in its entirety and bring to your initial session for you and your counselor to review. If you are unable to print and complete this form and bring it to your initial session, please inform your counselor and plan on arriving 15-30 minutes before your Initial Session to complete this form.
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    CHILD DEVELOPMENTAL FORM (Parents/Guardians complete for ages 2-17)

     (125K)
    Parents/Legal Guardians: If your child (age 2-17) is the primary client, please print and complete this form in its entirety and bring it to your child's/teen's initial session. This form is used to provide the counselor a thorough developmental history, from the parent's/legal guardian's perspective, about the child/teen client, and to provide the counselor insight, from the parent's/legal guardian's perspective, about the reasons for seeking counseling services. The last two pages can be separated for each respective parent to complete independently and provide to counselor.
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    CONSENT TO ENTER TREATMENT FORM

     (186K)
    This form is for adult clients and parents/legal guardians of minor clients to consent to the client to enter treatment. Parents/legal guardians of minor clients must review and sign and fax or provide in hand to their child/adolescent's counselor at (855) 462-9865 BEFORE or AT the child/adolescent's Initial Session.(Parents of a minor who is has been named in a Custody Agreement must both sign this form AND provide a copy of Custody Agreement stating conservatorship to counselor BEFORE a child enters treatment).
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    CREDIT CARD AUTHORIZATION FORM

     (45K)
    This form must be completed at initial appointment for all unpaid balances, no show or cancelation fees, according to the office policy stated in the Informed Consent form.
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    For Tricare PRIME Members only

     (25K)
    Before your first session, please complete the steps on this form to obtain your Authorization for counseling services to be considered by your Tricare/Value Options benefits, if you are a Tricare PRIME Member. Bring this form with your Authorization to your counselor. **Claims may not be successfully processed without this form and the TRICARE member/client is responsible for any unpaid balances. (Tricare Standard Members do not need to complete this process).
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    For Tricare STANDARD Members only

     (51K)
    Tricare STANDARD Members must have a Physician Referral and Ongoing Communication Form completed by their referring physician for their claims to be considered by their insurance. **Claims may not be successfully processed without this form and the TRICARE member/client is responsible for any unpaid balances.
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    HIPPA NOTICE OF PRIVACY PRACTICES

     (222K)
    To obtain a copy of my practice's HIPAA Notice of Privacy Practices, please click on this form and download at your convenience.
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    RELEASE OF CLIENT INFORMATION AUTHORIZATION FORM

     (69K)
    This form must me entirely completed and signed if the client (parents/legal guardians complete and sign for minor client) would like the counselor to coordinate care and communicate with third party individuals or organizations. PLEASE RETURN SIGNED BY FAX OR EMAIL
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    REQUEST FOR CLINICAL DOCUMENTATION OR TREATMENT RECORDS

     (56K)
    Stephanie A. Richards, LPC-S requires this form to be completed and signed as a formal and written request for the release of clinical documentation and treatment records. This request form provides information to the counselor about the specific nature of the request that allows the counselor to appropriately and safely release sensitive client information. This form must also accompany and be submitted with a proper Authorization for Release of Information signed and dated by the client, parent/legal guardian(s) or personal representative, which identifies the records to be disclosed and the person or entity to who the records are to be disclosed, to accompany any request for records.