Forms
Please fill out and send these forms back to me prior to your first session.
| kl_intake_paperwork_2019.doc |
| kl_hipaa_consent.docx |
Please download and read HIPAA.
| hipaa.pdf |
If I am in-network with your insurance plan and you plan to use your benefits, please fill out and send these forms back to me prior to our first appointment. No need to complete these forms if you plan to file for out-of-network benefits.
| insurance_verification_form.docx |
| insurance_benefit_information.docx |
I have one pay-what-you-can slot available for activists. If you would like to apply for this slot, please fill out this application and return it to me. I will review it and let you know if you are accepted as I am able!
| application_for_pay-what-you-can_slot.docx |
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The way of love is not a subtle argument. The door there is devastation. Birds make great sky-circles of their freedom. How do they learn it? They fall, and falling, they're given wings. ~ Rumi |
