Forms
Please download,  print, review, fill out, and sign the following forms before beginning counseling (as each form dictates). Doing this
before your session will save you valuable counseling time, as well as help you learn about the counseling process at your own pace.  

To download these forms, simply double click the underlined links below, open, and print. The first 5 forms are in .pdf-format.  To open
them, you will first need Adobe Acrobat Reader on your computer. If you do not already have this on your computer, you may download
it for free by double clicking the image below and following the instructions:




The following 2 forms are
required for you to download, read, sign, and return me at our counseling session:

1)  
Client Information:

This form is where you write down your personal information for my records so I may contact you as needed and understand your
presenting issues. (2 Pages)

2)  
Informed Consent:

This form only requires your signature after review. It contains a description of the main terms, conditions, and process of our
counseling work together. (3 Pages)

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The following confidentiality-related form is required for you to download and review according to HIPPA guidelines and regulations
before our first session, but you do not have to sign it or bring it in to the counseling session:

3)  
Notice of Privacy Practices:

This form explains in detail the limitations of privacy and confidentiality regarding our discussions and records from our counseling.
Federal law mandates that you are given this form in the beginning of our sessions together. (2 Pages)

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This form is optional and is only used on an “as needed” basis:

4)  
Release of Information:

This form is what you fill out to legally grant permission for myself and another person or entity of your choosing to discuss or share
information or records from our counseling process together. You only need to complete and return this form to me if there is another
individual or entity that you wish for me to share your confidential information with. If you have no one you desire that I share your
counseling information with, you do not need to worry about this form.  Examples of those you may wish their confidential information
shared with may include a spouse, parents, children, friend, lawyer, court officer, probation officer, teacher, etc. (1 Page)

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These 2 forms are for those clients coming in for clinical hypnosis only:

5)  
About Hypnosis:

This form will inform you of the nature and limitations of clinical hypnosis. You only need to review this form if you would like hypnosis
to be a part of your counseling process. You do not need to sign it or return it. However, on your informed consent for treatment, you
agree in writing that you have reviewed this form if you receive hypnosis. Therefore, it will be up to you to be familiar with it’s contents.
Feel free to ask me if you have any questions about the nature, process, and limitations of hypnosis. (1 Page)

6)
 Hypnosis Questionnaire:

This questionnaire needs to be answered and emailed back to me prior to our first hypnosis session (for those coming in for
hypnosis).  I will use these answers to create personalized outlines for our hypnosis sessions together. It is in Microsoft Word (.doc)
format so you can make changes to it and save it directly on your computer. First, double-click the link above to download this form to
your computer. Choose a location for it where you can easily retrieve it. Then, open it up, answer the questions, save the new
amended file with your answers, and email it back to me as an MS Word (.doc) attachment. My email address to send it to is
drgilchrist@yahoo.com.  (1 Page)
Randy Gilchrist, Psy.D.
1899 East Roseville Parkway Suite 100
Roseville, CA  95661
(916) 899-4990   drgilchrist@yahoo.com
Counseling and Psychotherapy Services
Licensed Clinical Psychologist #PSY19726
Licensed Marriage and Family Therapist #MFC39159