FORMS

After you have completed the needs assessment on the phone, please fill out and sign these 4 forms and email them back to me.

Informed Consent

Informed Consent for Telehealth

rRelease of   Information

Rights & 
Responsibilities

For CCS and CCF clients

Click below for the Referral Form

CONTACT ME

Please call me at 608-347-1432 and leave a detailed message and a good time for me to return your call. 

I begin with all clients over the phone with a “needs assessment.” During this call, I learn more about your needs and intended outcomes for services.

 

Rate Breakdown:

  • The needs assessment by phone takes around 30 minutes and is free of charge. 

  • Rates for all services is dependent upon the scope of work requested.

You can pay via cash, check, or by clicking the "donate" button below (which allows you to pay with PayPal, or a credit/debit card.)

  Contact Information. 

 Email: jessie@collective-voices.com 

  Phone: 608-347-1432   

 

I can travel to your location anywhere 
in the States or abroad.

 

Mailing address:
1121 N. Johns St. 

 P.O. Box 243 

 Dodgeville, WI 53533 

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