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