Forms

If you're ready to fill out the forms below, sign up for counseling here.  Please contact our office by phone at 859-279-2949 if questions arise.

Below is a list of necessary documents to complete prior to the first counseling session.

• notice-of-privacy-practices-4252020-10-23-2020-11-12-pm.pdf
• informed-consent-for-counseling-4252020-10-23-2020-11-11-pm.pdf
• addendum-informed-consent-for-technology-assisted-services-4252020-10-23-2020-11-11-pm.pdf
• audio-videotape-recording-4252020-10-23-2020-11-13-pm.pdf
• credit-debit-card-payment-consent-starting-412022-03312022-0229-pm.pdf

If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), be prepared to complete this form to authorize release of psychotherapy information:

• Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, Click here.