Adam Vellturo Counseling Services
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Adam J. Vellturo Counseling Services​
*Offering Telehealth Remote Counseling Services Throughout Arizone
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Client Forms
Below you will find PDF files of forms that need to be
reviewed and filled out prior to our first meeting.
The Patient Service Agreement and The Notice of Private Practice , need to be reviewed in their entirety on your device. The Client Information , The Consent to Treat/Disclose ,
​and The Informed Consent for Telehealth Services forms need to be printed, filled out and signed.
These form along along with your Insurance Card (if applicable) need to be scanned and emailed to avcounseling1@gmail.com
Patient Service Agreement
File Size: 61 kb
File Type: pdf
Download File

Notice Of Privacy Practices
File Size: 43 kb
File Type: pdf
Download File

Client Information
File Size: 20 kb
File Type: pdf
Download File

Consent to Treat/Disclose
File Size: 22 kb
File Type: pdf
Download File

Informed Consent for Telehealth Services
File Size: 45 kb
File Type: pdf
Download File

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  • Home
  • Services
  • About
  • Contact
  • Client Forms
  • FAQ