Forms

Forms will be sent to you before your first session. These are the forms new clients complete; downloads will be added to this page.

New client information (child or adult): contact details, background, and what brings you in.

Consent to treatment: how therapy works, and confidentiality and its limits.

Telehealth consent: how video sessions work and how your privacy is protected.

Email consent: permission to communicate by email, and what email is used for.

Fee agreement: fees, payment, and the cancellation policy.

Notice of privacy practices: how your health information is used and protected.

Good Faith Estimate notice: your right to an estimate of expected costs.

Release of information: permission for Dr. Kalnicki to speak with a school or doctor.

Completed forms go directly to Dr. Kalnicki, not through this website.