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Counseling Services Paperwork

This paperwork is for psychotherapy services only.

Intake Questionnaire

Service Agreement

Insurance Clause

Credit Card Authorization

Couples Intake

Child Intake

Adolescent Informed Consent

Release of Information

Intake Questionnaire- Spanish

Psychiatric Services Paperwork

This paperwork is for medication management only.

New Patient Pre-Screening Form

Records Request Form

Intake Questionnaire

Informed Consent

Controlled Substances Agreement Form

HIPAA Agreement Form

Credit Card Authorization

Release of Information

Office Address

308 Wolfe St

1st and 2nd Floors

Fredericksburg, VA 22401

Main Office/Appointment Line: 540-370-6983

©2019 by Kairos Counseling.

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