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 Policies and Forms

Informed Consent Ages 13 and Under

Informed Consent Ages 14-17

Informed Consent for Adults

HIPPA- Notice of Privacy Practices Policy

Social Media Policy

Release to Contact PCP

Authorization for Release of Mental Health

Information

Credit Card Authorization Form

Fee Agreement and Financial

Policy

New Waters Counseling

3400 South Park Rd.

2nd Floor, Suite 9

(Above Ruthfred Market)

Bethel Park, PA 15102

​

412-368-3443

luke@newwaterscounseling.com

Schedule a session:

Mon- 4 pm- 10 pm

Tues- 4 pm- 10 pm

​Wed- 4 pm- 10 pm

Thur- 4 pm- 10 pm

Fri-    4 pm- 10pm

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