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
For Clinical Hypnosis 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