Mantis Counseling and Coaching LLC
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Forms

Please read and print any necessary forms before your scheduled appointment.
Feel free to ask any questions you may have regarding forms.

  • Intake Information
  • Demographic Information
  • Notice of Privacy Practices
  • Authorizations

Coaching Forms

  • Client Data Form
  • Coaching Agreement
  • Client Policies and Procedures
  • Client Preparation Form

All forms are in PDF format. If you are having problems opening the forms you may need to download Adobe Reader.

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As per the “No Surprises Act”, beginning on January 1, 2022, you may request a Good Faith Estimate of services you may be receiving and the expected cost of that to you over the duration of treatment at any time. This only applies if you are not using insurance coverage from an insurance plan provider or if you do not have insurance coverage. If you have insurance coverage and choose to use it for services, you may request this information from your insurance provider.
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