Forms

Our “Forms” page is designed to help you find and download the forms you need quickly and easily.  If you cannot find the form you need or have questions about what forms to complete after reviewing this page, please email us at info@spectrumsocial.net and we will be delighted to assist you.

For quick access – select the forms you need:
Social Skills Group Application
Counseling Interest Form
Group Enrollment Forms (after you have been enrolled in a group)
Volunteer and Intern Paperwork

Who To Contact For Questions About Groups

Social Skills Groups

View our Fall 2017 – social skills flyer for information on current social skills groups

 

To apply for Social Skills Group

Please start by reading our Fall 2017 Spectrum Social Group Enrollment Information, Tuition Rates, and Schedule Availability to assure you understand our fees and enrollment expectations.

To apply for a social skills group please begin by completing these forms:

Start by completing our Applicant Contact Form

Then complete our Schedule Availability E-Form page to help us understand what your availability is for enrolling in a social skills group.

Next, complete the Applicant Information form based on your age/grade:
Adult Social Group Applicant Information

1st-12th Grade Social Group Applicant Information

Submit these completed forms to us by email office@spectrumsocial.net or fax to 512-524-1177. Forms can be mailed to: PO Box 10806; Austin, TX 78766.

You may also bring them to our offices at 8105 Shoal Creek Blvd., Ste. B.  Due to the nature of our services, we do not always have someone at the front desk.  If no one is available to accept your form (or for your convenience) you can leave the competed form in our drop box located at the staff entrance door in the back parking lot.

GROUP ENROLLMENT FORMS – are listed below.  Please DO NOT complete these forms until your enrollment has been confirmed.

Client Hipaa Rights and Notice E-Form
Consent For Emergency-Medical Treatment E-Form
Liability Release E-Form
Photo Digital Images Release
Spectrum Payment and Service Policy
Some additional forms may be needed depending on the group and your specific needs.  The administrator for your group will advise if you need these forms:

Transportation Release
Seizure-Action-Plan
Consent to Communicate
referral for services by agency
Spectrum Credit – Debit Authorization eForm

You may also choose to review
Spectrum’s NOTICE OF PRIVACY PRACTICES Omnibus Rules
related to our protection of your personal health information

 

If you have specific questions about social skills groups please contact:

Jole Lehr-Fizer for Elementary (1st – 5th grade) Groups
Jan Motriuk for Secondary (6th – 12th grade) Groups
Amanda Pena for Adult Groups

Or call 512-524-5482 – if no one is available to take your call leave a message with the answering service and we will respond as soon as possible.

Counseling Forms

Start by completing our Applicant Contact Form and then submit by email to
Amanda Pena, our lead therapist.  Amanda or another therapist will contact you to discuss your specific needs in confidence and determine the next step to provide the support and assistance needed.

Volunteers and Observersclick here for forms and information page