Dear New Client,
Welcome to Ampersand Sexual Violence Resource Center, and thank you for choosing to work with us! Before your appointment, we ask that you complete the following:
Client Information Form
: You may have given us some of this information via phone, but the form will help verify accuracy. While several items are required (marked with an asterisk
), others may be provided based on your comfort level.
Client’s Consent Form
Client Code of Conduct
HIPAA – Use and Disclosure of Protected Health Information
In the event of a late arrival, your session will end at its regularly scheduled time.
If you have any language/accessibility needs, please call to let us know before your appointment.
For questions about your appointment, please call our business office at (859)253-2615.
If you wish to talk to someone immediately, please call our crisis line at 1-800-656-HOPE (4763).
Thank you for your confidence in Ampersand Sexual Violence Resource Center. We look forward to serving you!