Paperwork for New Clients Information for Clients Before completing the following Intake please read this document carefully. Intake Please click here to complete and submit your intake paperwork to Dr. Erwin electronically. The intake will take you approximately 30 minutes to complete. Please complete and submit the paperwork the evening before your appointment to allow Dr. Erwin time to review it before your appointment. When you click on the Intake link you will see that the address begins with https (instead of http) and your address bar has turned green. This indicates that the information you provide on this form is completely private (encrypted). For Horizon Health Clients Only If you are a Horizon Health client, please print and sign this document and bring to your first session. Don't forget to bring your Horizon Health Authorization number. to your first session. Debit/Credit Card Change Form Use this link if you wish to change the debit/credit card you have on file with Dr. Erwin. When you click on the Intake link you will see that the address begins with https (instead of http) and your address bar has turned green. This indicates that the information you provide on this form is completely private (encrypted). |
| Terry McVannel Erwin, Ph.D. Dr. Erwin is a General Practitioner With a Special Interest in Working with Women Survivors of Childhood Sexual Abuse Qualified Supervisor, FL Certified in Clinical Hypnosis National Certified Counselor #78891 Licensed Mental Health Counselor #MH8591 |
| HOME DR. ERWIN'S SPECIALTIES IS COUNSELING RIGHT FOR YOU? PERSONAL STATEMENT ABOUT CLINICAL HYPNOSIS COST OF SERVICES CONTACT DR. ERWIN PLEDGE TO LGBT CLIENTS AFFIRMATIONS AND MORE PAPERWORK FOR NEW CLIENTS DOWNLOADS/LINKS FOR CURRENT CLIENTS DIRECTIONS TO OUR OFFICE 2504 Del Prado Boulevard South Cape Coral, FL 33904-4750 Ph. (239) 242-0545 TErwin1@yahoo.com Don't have insurance? We offer limited-session sliding scale fees that are comparable to insurance co-pays! Call today for more information! |
