For New Patients
Please download the first four forms, fill them out and bring them to your first appointment.
- HIPPA Notice of Privacy Practices – 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 session on the telephone
If we are to do counseling on the telephone or over the internet, even for one session, I must have a signed copy of this form. Please print and sign.
If I will need to speak to a teacher, an attorney, a doctor or any one else, I will need to you fill out this form which will give me permission to do so.
Thank you,
Steven C. Kassel, MFT, BCIA-c, BCIA-EEG