FORMS

Your Journey to Wellness Starts Here.

HIPAA-Badge.png

The information requested is part of the process of working together, all of which contribute to an optimal outcome.  

 

If you are a new patient, please complete and sign all forms and be sure to bring your insurance card and driver's license (front/back) to your initial visit or send them to kate@livingponocounseling.com

NEW PATIENTS ONLY

  1.  Contact Living Pono to speak with a therapist or staff member before completing forms.

  2.  Verify Insurance

  3.  Read Client Contract  

  4.  Complete Client Intake Form 

  5.  Complete Credit Card Authorization  

  6.  Complete Release of Information 

  7.  Complete Safe Harbor Agreement 

  8.  Complete Document Request Form  

  9.  Complete Cancellation Policy, where applicable

 

Start your wellness journey now.