For your convenience, the following forms are provided here for you. Please follow the instructions listed after each form. If you will be doing distance therapy, please complete and sign the appropriate forms (for Disclosure Statement, you want the one entitled, “Disclosure Statement for Distance Therapy) and either scan/email them to me (sharon@sharonkocina.com).
Prior to your first session, please watch the video at the bottom so you know what to expect
For Everyone:
- Client Contact Form (print and complete one copy of this form prior to session)
- Client Information Form A (print and complete one copy of this form per person prior to session)
- Disclosure Statement (print off 2 copies of this and bring to 1st session; please notice this is 2 pages)
- Disclosure Statement for Distance Therapy (used for complete form including signature and either scan/email or fax it to me)
- Additional Policies and Information (print one copy, read and sign; bring to 1st session)
- Release Form (not needed unless specifically requested)
In addition to the above forms, please add the following based on your payment method.
Self Pay:
- Fee Policy (print off 2 copies of this and bring to 1st session)
or
Insurance (I’m currently an in-network provider for Aetna, Anthem/Blue Cross Blue Shield and Cigna):
- Fee Policy with Insurance (print off 2 copies of this and bring to 1st session)
- HIPAA Privacy Form (only needed for insurance)