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New Hope Counseling Center

PROFESSIONAL COUNSELING WITHIN A SPIRITUAL CONTEXT

 

616 Barnett St, Kerrville TX 78028

(830) 257-3009

  E-mail: newhope1@ktc.com

Fax: (830) 257-3061

 

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To view, click on the name of the desired form. The form will be displayed in a separate window from which it can be printed.
 

Notice of Privacy Practices

 

This notice describes how your protected health information may be used and disclosed and how you can obtain access to this information. Please review it carefully. (2 pages)
Assignment of Benefits By signing this form you are allowing us to release your private health information to your insurance company so that your claims can be processed and paid accordingly. If you do not sign this form we cannot treat you.
 
(1 page)   pdf form
Intake Form A form requesting personal and insurance information, policies, procedures, and consents. Your initials and / or signature are required on each page. (5 pages)
Intake Form - Child A form for parents to fill out for minor patients. (3 pages)
   
 

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