Kim Brulay LMHC THERAPIST
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  • Therapy Services
    • Adults
    • Adolescents
    • What to Expect
    • Combat Vets
    • SUICIDE RISK FACTORS
  • About Kim
  • Insurance/Pay
  • Location
  • Contact Me
  • 5 FORMS
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1. Personal Info & History
2. Informed Consent for Therapy
3. HIPAA Privacy Practices
4. Financial Responsibility
5. Text/Email Consent

If you are able to use a conversion program and fill these out online, then please do so and email them to me after completing: [email protected]

Otherwise, Please download, print, and fill out the forms,
and remember to bring all 5 forms with you!
🙏
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*For PARENTS: print only 1 page of forms #2 thru #5 for both you and your child to sign, but your child fills out #1 form
*For COUPLES: print only 1 page for forms #2 thru #5 and sign along with your spouse/partner; print one copy each for couples of form #1

If you have any questions, please contact me!

  • Home
  • Therapy Services
    • Adults
    • Adolescents
    • What to Expect
    • Combat Vets
    • SUICIDE RISK FACTORS
  • About Kim
  • Insurance/Pay
  • Location
  • Contact Me
  • 5 FORMS