Forms

Please print the client paperwork forms, complete them, and bring them with you to your first appointment. (Please do not email the forms to me).

Your initial appointment:

During this appointment, we will meet to  help me understand your issues and concerns. After the first 2-3 sessions, we will develop a plan to address your issues in subsequent sessions.

If you are seeking Individual Counseling, please print and complete the following:

If you are seeking Couples Counseling, please print and complete the following.

Requesting Personal Health Information

  • To send a Release of Information Request or Release of Information Forms to Hope in Healing Counseling and Wellness, LLC/Stacy Nunne, please contact Stacy at 952-215-5208 to establish a secure way to send the release of information request and forms. (To send requests in a secure way, we need to establish a secure email exchange).

CONSENT FOR RELEASE AND EXCHANGE OF INFORMATION

REQUEST FOR A COPY OF MY PERSONAL HEALTH INFORMATION

FOR YOUR INFORMATION

HIPAA Privacy Notice and Hope in Healing Counseling and Wellness, LLC Privacy Practices

MN Client Bill of Rights

If you have any questions regarding these forms, please call Stacy at 952-215-5208.