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.Ā 

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 (make sure you note where the file is saved). After downloading the files, clicking on the files will open them with your Adobe Acrobat Reader. If you do not have the Reader, it is free and can be downloaded safely by clicking here [please link to: https://get.adobe.com/reader/]. You can then print off the form, fill it out and then send it to me via email, fax or mail (see my email information, etc. at the bottom of the page).

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 (make sure you note where the file is saved). After downloading the files, clicking on the files will open them with your Adobe Acrobat Reader. If you do not have the Reader, it is free and can be downloaded safely by clicking here [please link to: https://get.adobe.com/reader/]. You can then print off the form, fill it out and then send it to me via email, fax or mail (see my email information, etc. at the bottom of the page).

For more detailed directions to download these files, scroll down to the bottom of this page or click here.

Three basic forms:
Intake Form
Office Policies Form
Client History Form

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

Consent To Treat Minor Form

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

Insurance Information and Authorization Form and the
PCP (Primary Care Physician) Request For Information Form

The following form is only used occasionally to share or obtain information

Authorization to Exchange Confidential Information