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

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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. 

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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.

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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. 

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 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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