Rebecca Lowry, LPC
336.794.4008
2990 Bethesda Place #604-A
Winston Salem, NC 27103
rebecca@rebeccalowry.com
HELPFUL FORMS


If you're a first-time client, please review and complete the following forms and bring them to your first session.

  • Client Intake Form
  • Limits of Confidentiality/Cancellation Policy Form
  • Disclosure Statement

 The following forms are for your information. Please review and retain in your files.

  • Office Policies
  • HIPPA Policy

If you would like me to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), complete this form:
 

  • Consent to Release / Exchange of Information Form

 


Confidentiality and Cancellation Policy  
Client Information Form Client Intake Form
Consent to Release Exchange of Information
Disclosure Statement  
Office Policies For your files
HIPPA Policy For your files

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