New Patient Forms

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For New Patients

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

Consent Form

Patient Registration

HIPPA Notice of Privacy Practices

Credit Card Approval Form

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