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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 medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. (2 pages) |
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Consent Form |
By signing this form you are agreeing to let us use your medical record information and to send it to your insurance company. If you do not sign this form we cannot treat you. (1 page) |
| Intake Form | A form requesting personal and insurance information, policies, procedures, and consents. Your initials and / or signature are required on each page. (6 pages) |
| Intake Form - Child | A form for parents to fill out for minor patients. (3 pages) |
| HCFA Form | Health Insurance Claim Form. If using insurance, bring your card and the signed and dated form with you on your first visit. It's not necessary to fill out the entire form. (2 pages) |
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©2006 - 2007 New Hope Counseling Center, Kerrville, TX |
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