Client Forms

For your convenience, the following forms are provided here for you. If we are meeting in-person, print these forms (notice if a form has more than one page), fill them out and bring the completed forms to the 1st session. If we are meeting via telehealth, email or fax a copy of these forms to me prior to the 1st session.

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 (If we are meeting in-person print off 2 copies of this and bring to 1st session [one copy is yours]; please notice this is 2 pages. If we are meeting via telehealth, email or fax a copy of both pages to me at sharon@sharonkocina.com)
  • Additional Policies and Information (print one copy, read and sign; bring to 1st session)
  • Credit Card Form (print and complete one copy of this form prior to 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, Cigna and United Healthcare):

First Session: What to Expect

Helping You on the Path From Surviving to Thriving