Forms
Please fill out and send these forms back to me prior to your first session.

kl_intake_paperwork_2019.doc | |
File Size: | 69 kb |
File Type: | doc |

kl_hipaa_consent.docx | |
File Size: | 13 kb |
File Type: | docx |
Please download and read HIPAA.

hipaa.pdf | |
File Size: | 76 kb |
File Type: |
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 | |
File Size: | 506 kb |
File Type: | docx |

insurance_benefit_information.docx | |
File Size: | 14 kb |
File Type: | 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 | |
File Size: | 25 kb |
File Type: | docx |