Fill Out Forms

Please print the following pages and send them promptly via mail or fax:

Michelle “Mickey” Simpson LSCSW

8010 Stateline Road, Ste 101

Prairie Village, KS 66208

Secure Fax Line: 913-385-0004

 

Download, Complete, and Return all forms in the ‘Getting Started’ packet.
All forms should be returned at least 24 hours prior to your first session

Getting Started Packet  [PDF – 12 pages]

Release of Information  [PDF – Not Required for All Patients]

 

If you don’t have access to a printer feel free to request the packet of forms and they will be sent to you. Simply email me at: mickeysimpson@earthlink.net

Congrats, you are taking time to empower yourself.

Here WE go, we will be in this together. :)

 

As a mandated reporter for the States of Kansas and Missouri, all clients, regardless of payment type, face the same guidelines based on the ethics of being a Licensed Specialist Clinical Social Worker (L.S.C.S.W.) and a Licensed Clinical Social Worker (L.C.S.W.). It is a social workers duty to maintain confidentiality, as well as report suspected child or elder abuse. Act proactively in the event of harm, via a plan for suicidality or homicidality. In the event that the Clinician is ordered by a judge to hand over documentation or appear in court, the Clinician will do so.

In the event your mental health concerns are an emergency and cannot wait for a response, please contact your local emergency room and/or call 911.