forms

Below are the forms that we will cover during your initial session.  Please download, print and bring both completed forms with you to your first appointment.  

Disclosure Statement
File Size:	87 kb
File Type:	pdf

Download File

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Covid Protocol, Disclosure and Consent
File Size:	120 kb
File Type:	pdf

Download File

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Good Faith Estimate
File Size:	134 kb
File Type:	pdf

Download File

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Intake Form
File Size:	95 kb
File Type:	pdf

Download File

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Telehealth Disclosure and Consent
File Size:	110 kb
File Type:	pdf

Download File

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Audio Only Telehealth Disclosure and Consent
File Size:	87 kb
File Type:	pdf

Download File

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Notice of Privacy Practices
File Size:	133 kb
File Type:	pdf

Download File

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jamelyn@jamelynkeatts.com​ // 408.836.2896