Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

INSTRUCTIONS FOR CLIENT INFORMATION FORM:
- If you are the client, enter your information
- If you are a parent, enter your child's information, except for their cell phone number (enter your number instead)
Thanks!

Client Information

/ Middle Initial

( optional )
 

( MM-DD-YYYY )







( for Text Message Reminders )

Bill To Contact

/ Middle Initial







Log in Details

( If client is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )




( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

Credit/Debit Card Policy

Clients are required to have a debit/credit card on file in their secure account in my electronic health record system for as long as they are receiving services. By accepting this policy, you are consenting to allow Our Story Youth & Family Therapy LLC to charge your debit/credit card for sessions and late cancellation fees (for individual and family therapy clients only). Your card will be charged following each session and you will receive an email notification. I will let you know if your card is denied for some reason and you can update your card information via the client portal.

( Type Full Name )
( Full Name )
Late Cancellation Policy

If you need to cancel a session, I ask that you notify me as soon as possible. For "no-shows" or cancellations made less than 24 hours in advance, a fee of $50 may be charged to your credit/debit card on file (for individual and family therapy clients only). I may choose to waive the fee for unforeseen or emergency circumstances such as sudden illness and dangerous road conditions. We may also be able to reschedule your session if I have an opening that week. If so, no fee will be charged. Consistency increases the effectiveness of individual and family therapy.

( Type Full Name )
( Full Name )
Electronic Communication Policy

Secure messaging is provided through the client portal on my website. If you wish to communicate electronically about more personal matters, the client portal is the most secure method. If you choose to use email instead, it is important that you understand confidentiality is not guaranteed. I may use unencrypted email to communicate about scheduling and to send handouts. Our Story Youth & Family Therapy LLC uses Google Meet for telehealth sessions, which is a HIPAA secure video platform.

( Type Full Name )
( Full Name )