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    242 East 7th North Suite 4 | Rexburg, ID 83440
    ostermillercounseling@gmail.com | (208) 359-9683
    Fax: (208) 359-0889

  • Ostermiller Counseling Services Inc.

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    Client Forms

    General Client Forms

    If you are new to working with us, please be sure to fill out the following forms, and bring them to your first session. This will help ease you in and allow as much time as possible to focus on you.

    Client and Insurance Information

    Client Rights

    Financial Policy

    HIPPA Consent

    Informed Consent

    Notice of Privacy Practices

    ALERT Wellness Forms for Clients with Medicaid

    Adult Wellness Assessment – English

    Adult Wellness Assessment – Spanish

    Youth Wellness Assessment – English

    Youth Wellness Assessment – Spanish

    Forms for Ecclesiastical Leaders of The Church of Jesus Christ of Latter-day Saints

    Ecclesiastical leaders will also need to download and review the form titled “Financial Policy” under General Client Forms.

    LDS Bishop or Stake President Payment

    Release of Information Form

    If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

    Release of Information

    242 East 7th North Suite 4 Rexburg, ID 83440
    (208) 359-9683 ostermillercounseling@gmail.com
    Fax: (208) 359-0889

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    Ostermiller Counseling Services Inc.
    ostermillercounseling@gmail.com | (208) 359-9683
    Fax: (208) 359-0889

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