*PLEASE PRINT AND COMPLETE THESE FORMS AND BRING THEM TO YOUR NEXT SESSION.

*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; YOU ONLY NEED TO GIVE ME THE FORMS THAT ACKNOWLEDGE THEIR

     RECEIPT. THANK YOU!


KATHERINE WARD, LCSW