NEW CLIENT FORMS

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Instructions: Click to open your forms. Download and fill them out. Then email them back to me or print them out and bring them to your first appointment. Be aware that Email is not safe to transmit your private information. If you choose to submit your private information through email, you do so at your own risk.

 

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To See Dr. Steven Kovner Via Tele-Behavioral Health Video, Fill Out One Of The Forms Below

ADULT

COUPLE

ADOLESCENT

TELEHEALTH INFORMED CONSENT FORM

To See Dr. Steven Kovner IN THE OFFICE, Fill Out One Of The Forms Below

 

COUPLE

ADULT

CHILD

ADOLESCENT

 

For PSYCHOLOGICAL TESTING,

please select the appropriate form below:

If we plan on an interview using a Telebehavioral Video, please down load the Telehealth Informed Consent first and then one of the forms below. You must download these forms to your computer, save them once you’ve typed in your infromation and signed them electronically as instructed. Then, using my secure email link (Find the secure link in the email I sent to) send the forms back to me with a copy of your insurance card (front and back) and your drivers license.

 

ADULT

ADOLESCENT

CHILD

 

 

To See Ms. Kelly Deragon Fill Out One Of The Forms Below

 CHILD

ADULT

ADOLESCENT

 

  

Call Janelle if you have any questions

 

(770) 729-0123.

 

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