Kerschmann and Associates

PROVIDING COGNITIVE BEHAVIORAL THERAPY (CBT) AND CLINICAL SUPERVISION

Client Forms

Please read and complete the following forms prior to our initial visit.
Feel free to contact me with any questions you may have.

For All Incoming Patients
For Online/Telephonic Therapy Patients
To be completed prior to appointments (optional)
For Parents

If you are the parent of a patient who is under 18 please print & complete this form:
Developmental History

Other Documentation

Credit Card Authorization – Optional, for ease of payment
Release of Information – To allow consultation with other individuals and providers