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PROFESSIONAL COUNSELING WITHIN A SPIRITUAL CONTEXT |
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616 Barnett St, Kerrville TX 78028 |
(830) 257-3009 |
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| E-mail: newhope1@ktc.com |
Fax: (830) 257-3061 |
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FORMS MENU
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. |
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Notice of Privacy
Practices
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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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©2006 - 2010 New Hope Counseling Center, Kerrville, TX |
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