Forms
Therapy clients, please fill out and send these forms back to me by the night before our first session.
| kl_intake_paperwork_2025.doc |
| kl_hipaa_consent.docx |
Therapy clients, please download and read HIPAA and my Good Faith Estimate Notice.
| hipaa.pdf |
| good_faith_estimate_notice.docx |
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. There is no need to complete these forms if you plan to file for out-of-network benefits.
| insurance_verification_form.docx |
| insurance_benefit_information.docx |
If you are considering asking for a sliding scale fee, please read over these discernment questions.
| sliding_scale_discernment_questions.pdf |
New Client Info Packet
| new_client_recommendations.pdf |
For students, please fill out this intake form and send it back to me by the night before our first meeting.
| kl_teaching_intake_paperwork_2021.docx |
Once our first appointment is scheduled, please let me know whether you plan to use insurance to pay for our sessions. If you are planning to pay out of pocket, I will provide you with a Good Faith Estimate of the costs of your care before our first meeting.
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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 |
