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Compassion, Understanding, Healing

Kelly Bernstein, MS, LCDC, LPC


Alamo Heights Forensic and Individual Therapy

Forms

1. Client Intake Form

New Client Intake Form 2021 .pdf

(PDF — 113 KB)

2. Informed Consent Form

Informed Consent Signature Page 2021.pdf

(PDF — 108 KB)


3. HIPPA / Consent to Release Information Form

Authorization to Disclose Protected Health Information Form 2021.pdf

(PDF — 10 KB)

4. Adult Functional Assessment Tool

Functional Assessment Tool 2017.pdf

(PDF — 442 KB)

5. Consent to Treat a Minor

Consent to Treat a Minor 2021.pdf

(PDF — 496 KB)

6. Child History Form

Child History.pdf

(PDF — 76 KB)

7. Child Characteristics Checklist

Child Checklist of Characteristics.pdf
(PDF — 205 KB)

8. Fees and Policies

Bernstein Fees and Policies 2021.pdf

(PDF — 11 KB)

9. Credit Card Pre-Authorization

Credit Card Pre-Authorization Form 2021.pdf

(PDF — 361 KB)

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