Office Forms

Welcome to the Inner-healing Web Site
hosted by F. Michael Montgomery, LCSW, LMFT
LCS# 6184, MFC# 15488
Therapy for the heart, mind, body and spirit in a safe and healing setting.
This Inner-healing web site is a resource center for the support and promotion of personal growth and healing.
My desire is to support people in their own healing through the compassionate and courageous work of their hearts.

Office Forms

These are the forms I use for my office. To save time, it would help if you are able to fill these out before our first session rather than during it. Just click on any of the form links below and the file will be downloaded through your browser. After downloading the files, clicking on the files will open them to your Adobe Acrobat Reader. If you do not have the Reader, it is free and can be downloaded safely by clicking here .You can then print off the form, fill it out and then send it to me via email, fax or mail (see my contact information at the bottom of this page).

Four basic forms: (everyone needs to fill out these forms)
Intake Form 
Office Policies Form
Client History Form 
(if you are coming for couples’s therapy, each of you please fill out your own)
Telemedicine Informed Consent Form (for using the internet or the phone for psychotherapy)

Minor: (if a minor will be coming for therapy, please have a parent or guardian fill out this form)

Consent To Treat Minor Form

Insurance: (if you will be using insurance, please also fill out both of these forms)

Insurance Information and Authorization Form 
Primary Care Physician Request For Behavioral Health Information
(insurance companies require this)

Exchanging information: (only fill this out if directed to; it is rarely used in order to share or obtain information)

Authorization to Exchange Confidential Information