Group KAP
Final Intake and Consent Forms
Required for Participation in Your Group
Welcome! You’ve completed your intake interview and been approved to join our upcoming group series.
Thank you for your trust. We’re honored to support your process.
Before your first session, please complete the required documentation below. This is the final step before group begins.
What You’ll Complete
Informed Consent
Outlines the structure and purpose of the group, your rights as a participant, and mutual responsibilities.
Notice of Privacy Practices
Describes how your personal health information is protected under HIPAA and how it may be used.
Symptom Self-Assessments
Brief screening tools to help us better understand your experience:
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GAD-7 – Generalized anxiety
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PHQ-9 – Depression
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PCL-5 – PTSD symptoms
Submission Options
Option 1: Upload Online
Submit securely via our HIPAA-compliant Google Form.
Option 2: Print & Bring In-Person
Bring your completed forms with you to the first group session.
Deadline
All forms must be submitted by:
Friday, September 12, 2025
This ensures our team has these documents on file for the first group meeting.
Need Help?
If you have any questions or need support:
LuminaThera
(614) 982‑0262
info@luminathera.com
Have additional questions?
Perhaps you have questions about the program or your specific situation. Please send us an email with your contact info and availability, and we’ll connect to schedule a free 15-minute consultation.
Contact
+1 (614) 982-0262
info@luminathera.com
929 Harrison Ave Suite 200
Columbus, OH 43215
LuminaThera LLC
Provider of Psychedelic-Assisted Group Therapy in Columbus, Ohio