Kathleen Kawamura, PhD Clinical Psychologist
Kathleen Kawamura, PhDClinical Psychologist 

Client Forms

New clients will need to fill out several forms before therapy can begin. To make the process as smooth and efficient as possible, I have provided the most important documents as downloads. Filling them out in advance can save time in your first session, however they can also be available to be completed during your first session. 

Client Information Form
Please fill out prior to your first evaluation session. This will provide me with general background information that will help inform your treatment plan.
Client information.pdf
Adobe Acrobat document [214.0 KB]
Office Policies and Procedures
Please read and sign prior to your first evaluation session. This will provide you with information regarding what to expect in therapy, confidentiality, fees, and contacting me.
Office Policies and Procedures.pdf
Adobe Acrobat document [104.5 KB]
HIPAA Notice of Privacy Practices
Please read prior to your first evaluation. This will provide you with information regarding how your medical information may be used and disclosed and how you can get access to this information.
HIPAA Notice of Privacy.pdf
Adobe Acrobat document [312.1 KB]
Receipt of Privacy Practices Notice
Prior to your first session, please sign and bring in to indicate that you have read and understand the Notice of Privacy Practices.
HIPAA Acknowledgement.pdf
Adobe Acrobat document [177.5 KB]
Consent and Authorization to Exchange Confidential Information
Please fill out this form if you would like me to disclose information to other parties such as to current or previous providers or to family members who are participating in your treatment.
Release of Information.pdf
Adobe Acrobat document [9.3 KB]
Insurance Information Form
This form can be of help to you if you would like to better understand your mental health insurance benefits. If you call your insurance provider, they will be able to provide the information you need to fill out this form.
Patient Insurance Verification.pdf
Adobe Acrobat document [7.2 KB]

Note: You will need Adobe Acrobat Reader to view PDF files. If you do not have it, you can download it for free.