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Forms
If you are a new client, I would like to provide some addtional information before our initial session. Please download, complete and print these forms before your first appointment. This file contains the paperwork required for clients being seen by Denise Phillips at Gambling Solutions and Counseling Services of Michigan, P.L.C. It may seem like a lot of paperwork for you to complete, but it helps to make sure you are provided with the best assessment and treatment for you. In addition, these forms are required by many insurance companies and/or by law.
Prior to your first visit, please contact your insurance company and verify that I am listed as a provider: Denise Phillips, MSW, ACSW, LMSW, CAAC, NCGC-II/BACC. Some insurance companies require pre-authorization and they will provide you with an authorization number before your first session.
Included in this file is the Client Information Form for you to complete before your first session. Use this form to document insurance and contact information. If I am not listed as a provider with your insurance company, I suggest that you ask your insurance company if they reimburse for Out of Network, Licensed Master Social Workers for Outpatient Behavioral Health Therapy.
If you and/or your family member(s) are seeking help for problem gambling, funding for gambling treatment is available thru the Neighborhood Service Organization Gambling Treatment Program funded by the Michigan Department of Community Health. If you have questions about the eligibility requirements, please feel free to contact me directly regarding gambling treatment at Gambling Solutions and Counseling Services of Michigan, P.L.C.
When a 'witness' is required to sign a form, I will do so at the time of your appointment.
Please note that all files are in PDF format; to display and print correctly, they must be opened in Adobe Reader. Printing Forms: Please do not print these forms double-sided. While this saves paper, these forms will be placed in your file and single-sided pages are required.
Forms can be completed on your computer and printed. They cannot be saved or stored on your computer. If you would like to keep a copy for your records, print the completed form and bring a copy to your first session or fax them to Denise Phillips (248) 427-1317.
This information on problem gambling is offered solely in the interest of helping those individuals who have developed problems with their gambling behaviors. If you or someone you know exhibits the behaviors of problem gambling, seek help. The information provided here is not meant to be a substitute for treatment.