Michelle Roling, M.Ed., LMHC, CEDS-S

 

Sharing is Healing....

 
 
 

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Click on each link to complete the form before your first session...

In addition to these forms please complete biography when scheduling!

Client Information

Informed Consent

Release to Bill Insurance

Teletherapy form- EVERYONE Complete

Emergency Contact Information

Notice of Privacy & Bill of Rights

Parental Consent to Work with My Child 

Consent to Release Information  1-4 people/orgs

Additional release of information consents   5-8 people/orgs

ISU students sign this additional consent

ISU ATHLETES complete this consent form


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