605 Cherry St. Suite 320, Belton, MO 64012
(816) 226-4678

CV-19 Video Therapy Group Forms

To sign up for the CV-19 Video Therapy Groups, you will need to fill out these forms and return them to me (Alicia). You may fax them to 816-406-0046 or if you feel comfortable with it, you may scan them as a PDF and send them via email to alicia@vitaliscounseling.com . If you wish to, you can password-protect the PDF file and send that password to me separately by text or email.

Forms to Fill Out

Notice of Privacy Practices Pursuant to HIPAA