Electronic submission
The forms below can be submitted electronically.
- Download them to your computer.
- Fill them out.
- Save them as [your last name + file name].
- E-mail the completed forms to your Counselor or group facilitator.
Note: Keep in mind that e-mail is not secure. You assume some level of risk to confidentially every time you use or participate in any electronic medium. With this being the case, PathSeeker Virtual utilizes the “Electronic Signature” method to verify forms over the internet.
Under the Uniform Electronic Transactions Act or “UETA” released by NCCUSL in 1999.[1], the term means “an electronic sound, symbol, or process, attached to or logically associated with a record and executed or adopted by a person with the intent to sign the record.”
You electronic signature is a legally binding agreement. By typing your name to one of the forms below, you are agreeing that you typed acknowledgment is a legal substitute for an authorized signature.
Forms may be electronically signed and submitted to the counselor/Facilitator/moderator via e-mail.
Hard copy submission
The forms below can also be submitted through the mail.
- Open and complete the form.
- Print the form (don’t forget to save a copy for your records)
- Mail the completed forms to:
PathSeeker Center Inc.
c/o [your PSV moderator]
4905 Van Dyke Rd.
Suite 14
Lutz FL 33558
Forms
Notice of Informed Consent — Required for all Therapeutic and Support groups.
Intake Form — Required for all Therapeutic and Support Groups
Sexual Abuse Group Specifics — Required for participants of the PathSeeker Sexual Abuse Group
Limits of Confidentiality — Required for Support and Ministry Groups
HIPPA — This form is a requirement to view for all Support and Therapeutic groups.
PathSeeker Virtual: Connect to God. Connect to People.
A ministry of PathSeeker Center
