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Welcome Packet
When you come to Karner Psychological Associates
for your initial appointment, you will be be given a packet of
information about our office policies. These forms should be
read and signed before you meet with your therapist. In addition,
you will need to provide background and insurance information before
your appointment starts. If you like, you can download the forms in
advance, which gives you the opportunity to fill out the forms at
your leisure. Or, if you prefer, you can arrive at your first
appointment 15 minutes early to fill out the forms at our
office.
To print out the forms in advance, use the
following links. All forms must be completely filled out
before your first appointment begins. We also encourage you to read
KPA's notice of
privacy practices before signing any of the forms.
No Show Policy: Appointments that are
not canceled at least 24 hours beforehand are charged full
fee; insurance companies will not cover any portion of a
missed appointment, making the entire cost (not just the usual
copay) the responsibility of the client. Therefore, be careful to
schedule appointments only at times when you are sure that you can
attend. If you are going to miss an appointment, please contact the
therapist or receptionist (or- if after hours- the answering service
at 243-2169) immediately. If there are extenuating circumstances
(last minute illness, dangerous weather), we will generally waive
the late fee upon explanation.
The following forms (all 4 links) need to be read, filled out,
and/or signed:
KPA Welcome Packet
Important Message to All Patients
Contact and Billing Information
Patient Intake Information
Confidential Health Care Info Release
The following two forms are
optional.
The first two forms only need be signed if you want to
authorize the sharing of your clinical information with another
party, or if you want to make special restrictions on the sharing of
your patient records. Please read our privacy
policy to better understand how your health records are used and
protected.
This form is if you want to stay connected
with us through email correspondence.
This last form is for your
information only and does not need to be signed.
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