Call Us:  (402) 315-3522

Amber Fry Counseling, PC

Forms

Please print and complete prior to a telehealth visit:

telehealth.consent.3.15.20.docx

Please print and complete the following forms prior to your first visit:

Registration Information1.1.20.docx

Financial Policy & Billing Agreement.1.1.20.doc

Fee Schedule (effective 1.1.20).doc

Consent To Treat (Adult) 2020.doc

Consent to Treat - Children and Adolescents 2020.doc

Privacy Acknowledgement.1.1.20.docx

If needed, please use this form authorizing me to have contact with other professionals

Fry Release of Information.1.1.20.doc