REGISTRATION FORMS TO BE COMPLETED:

PLEASE COMPLETE AND SIGN FORM NUMBERS 1,2 AND 3 AND BRING THEM WITH YOU TO YOUR APPOINTMENT.  IF YOU ARE SEEING BETH KINCAID, MED, LPC, NCC, PLEASE ALSO SIGN FORM 4.  THE OTHER FORMS ARE FOR YOUR INFORMATION AND TO DOWNLOAD AS YOU WISH.

THANK YOU !

1)  CLIENT REGISTRATION FORM

OR

1)  CHILD REGISTRATION FORM

HIPAA NC NOTICE OF PRIVACY FORM

2)  HIPAA NOTICE OF PRIVACY SIGNATURE SHEET

FINANCIAL POLICY CLIENT COPY

3)  FINANCIAL POLICY SIGNATURE SHEET

4)  (FOR BETH KINCAID’S CLIENTS):  BETH KINCAID’S PROFESSIONAL DISCLOSURE STATEMENT SIGNATURE SHEET

 


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