THERAPY FOR THE WHOLE PERSON.
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Client forms

Below are my forms for you to review. You may print and fill them out in advance or paper copies will be available to you at your initial session. *For forms requiring a signature, please leave the signature blank until we meet.
New Client Information
Consent for Treatment
Notice of Privacy Practices -for review only
Receipt of Privacy Practices
Release of information

Optional Forms (For Review only)

client's bill of rights

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"The way to happiness is to go into the darkness of yourself. That’s the place the seed is nourished, the plant and the flower. You can only go upward by first going downward." 
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~James Broughton

Contact Me

Wild Roots Healing Collective
​Rainbow Marifrog, MA, LMFT
2917 International Lane, Suite 202
Madison, WI 53704

608-520-6207 (phone)
608-646-7531 (fax)
© Rainbow Marifrog, LLC
  • Home
  • About
  • Services
  • Supervision
  • Events
    • Wisdom Circles
  • Contact