Legal & Intake Documents

When starting your journey with LifeStar Salt Lake, you’ll be asked to fill out a few forms prior to receiving our services. You can print these out at home and come with them filled out, or get them from us in-person at the office.

Beginning Packet

This is the basic starting paperwork that everyone needs to read and fill out:

• • • Client Registration Form: Download PDF
    • Client Payment Form: Download PDF
    • COVID – Consent for Treatment Form: Download PDF
    • Professional Disclosure and Informed Consent Form: Download PDF
    • HIPAA Notice of Privacy Practices: Download PDF

Advanced Documentation

Depending on your work with LifeStar Salt Lake, you may need to fill out these additional forms:

• • • Third Party Information Letter: Download PDF
    • Third Party Payment Authorization Form: Download PDF
    • Release and Exchange of Confidential Health Information: Download PDF