These are the forms you’ll need to complete when seeing Katherine; they are in PDF format, and you will need Adobe Reader or a similar PDF application to read and print them. You can print and complete these yourself, and bring them with you when you first visit the office.
For your convenience, you can download the complete forms package as a “fill-in” PDF (including forms related to the 2022 No Surprises Act). This means you can use your PDF reading software (like Adobe Acrobat Reader) to enter the requested information, save it, and then provide the file to Katherine. You can also print the file and complete it manually.
Beginning 1/1/2022, U.S. federal law requires all existing and new clients to review and sign the No Surprises Act Disclosure and Release.
You can download the other forms individually as well:
- Consent Form
- HIPAA Release Form: This form describes the confidentiality of your medical records, how the information is used, your rights, and how you may obtain this information.
- Client Intake Form: General information, symptom checklist, etc.
- Financial/Billing Practices: Our policies about payments, insurance, cancellations, and related matters concerning client’s financial responsibilities.
- Release of Information Form: Only needed if you want to allow kTherapy to speak with a physician, attorney, teacher, or anyone else concerning your case.