Kim Jensen, LMFT

Forms

 

If you're a new client and we've scheduled an intake appointment, you may complete the following forms and bring them to your first therapy session.  Or, you may come to the office 10 - 15 minutes early and complete the intake forms when you arrive.

 

  • Client Psychotherapy Intake Form

 

  • Limits of Confidentiality/Therapy Cancellation Policy

 

  • Authorization to Treat a Minor

 

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:


  • Authorization to Disclose Private Health Information Form/HIPPA