Forms for Kimberly Kline, LPC

Click on form name to see and retrieve   (The Contract and HIPPA will always be necessary)

INITIAL CONTRACT FOR TREATMENT: All clients

HIPPA: Privacy statement: All clients

INSURANCE VERIFICATION:  to be used only if using  insurance for payment

TELEHEALTH EMERGENCY PLAN 

for telehealth clients

Kimberly does accept insurance but is only on limited number of panels so please contact your company (the number on the back of your card) to inquire whether you have mental health coverage with Kimberly.

You Only need to print these below if you are asked to do so:

Stress Checklist:

DEPRESSION INVENTORY:

Release of Information:  

Pre Session Questionaire:

Divorce Mediation forms: Click here