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FORMS

Your Journey to Wellness Starts Here.

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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 48 hours prior to your appointment, unless otherwise noted, 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

Contact Living Pono to speak with a therapist or staff member before completing forms, and to verify your insurance.

  1.  Read Client Contract  

  2.  Complete the Client Intake Form 

  3.  Complete Credit Card Authorization  

  4.  Complete Release of Information 

  5.  Complete Safe Harbor Agreement 

  6.  Complete the Document Request Form  

  7.  Complete the Cancellation Policy, where applicable

  8.  Complete your Medical Profile

 

Start your wellness journey now.

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