Intake forms

1. Please use this Intake Form to electronically submit your personal information.

2. Please print out the HIPPA Policy, Office Policy, and Statement of Agreement, sign them and bring          them to your first session. Otherwise you will need to fill them out in the office before we meet.

3. I will collect your credit card information at our first visit.

Thank you and I look forward to meeting you!

question-answers

TO SCHEDULE AN APPOINTMENT

TELEPHONE

859-338-8720

E-MAIL
stevensmithpsychologist@gmail.com