Kathleen Kawamura, PhD Clinical Psychologist
Kathleen Kawamura, PhDClinical Psychologist

Patient Forms

 

New patients 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. Select the appropriate download link and bring the completed documents your first session. Naturally, all forms are also available at the practice; however, filling them out in advance saves time.

 

Client Information Form:  Please fill out prior to your first evaluation session.  This will provide me with general background information about you.

Treatment Consent Form: Please read prior to your first evaluation session.  This will provide you with information regarding what to expect in therapy, confidentiality, fees, and contacting me.  (pdf file link under construction)

Notice of Privacy Practices: Please read prior to your first evaluation.  This will provide you with legal information regarding your medical records.  Receipt of Privacy Practices Notice:  Please sign to indicate that you have read the Notice of Privacy Practices.   

Insurance Information Form:  Please fill this out prior to your first evaluation if you are choosing to use insurance benefits. 

Release of Information:  Please fill this out if you would like me to disclose information to other parties.

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