For New Patients

Please download the first four forms, fill them out and bring them to your first appointment.

*To see a full copy of the HIPPA Privacy Practices Law, click here.

Other forms which may be needed.

  • HIPPA Release Form – So that I may talk to your attorney, physician, teacher school counselor or other third party.
  • Telemedicine Informed Consent Form – If we will be doing a therapy on the telephone or over the internet, even for one session, I must have a signed copy of this form. Please print and sign.

Thank you,

Steven C. Kassel, MFT, BCB, BCN, AAPM