If you're a new client, please complete the following forms and bring them to your first therapy session.
- Acknowledgment of Privacy Practices
- Client Registration Form
- Financial Policy and Missed Appointment
- Hippa Form for Non-Medicaid
- Consent Form
- Release Form
- Adult CKCS INTAKE SOONERCARE REVISED 12-2017 -Adult Assessment.pdfSignature Page
- Professional Disclosure Statement
- Client Rights
- Child CKCS INTAKE SOONERCARE REVISED 12-2017 -Child-Minor Assessment.pdf
- If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
Note: To download Adobe Acrobat Reader for free, click here.