KATHERINE WARD, LCSW


*PLEASE COMPLETE THESE FORMS AND BRING THEM TO YOUR FIRST SESSION

      OR SIGN, SCAN AND EMAIL THEM TO ME AT KBWARD59@GMAIL.COM

*YOU ONLY NEED TO COMPLETE THE FINAL FORM IF YOU ARE USING INSURANCE TO

      HELP COVER SESSIONS WITH ME.

*PLEASE KEEP THE DISCLOSURE STATEMENT AND NOTICE OF PRIVACY PRACTICES

     FOR YOUR RECORDS AND RETURN THE FORMS THAT ACKNOWLEDGE THEIR

     RECEIPT. THANK YOU!