PATIENT FORMS AND PAYMENT INFORMATION

ABOUT PAPERWORK AND PAYMENTS

Please do not use an iPhone to photograph paperwork. 

Paperwork

A.) Copy both sides of your driver's license. Copy both sides of your insurance card(s), if applicable. 

B.) #1 Adult Intake Form if you are 18 or older, or 

#2 Child Intake Form if the patient is 17 years or younger. 

C.) #3 Health Questionnaire Form - Complete - for all.

D.)  #4 Informed Telehealth Consent Form - for all. 

E.) #5 HIPAA Document is a READ ONLY form - for all. 

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(B.)  Payment is due at the time of each session and at the start of the evaluation process. 

1. Sign up for Zelle® with your online bank account.

2. Go to "Transfer | Zelle®" at bank account page top. 3. Go to "Send Money" TO EMAIL: KW@KENFIELDWALTERS.COM

Zelle is EASY, FREE, VERY FAST!

*An additional fee is required if you use Pay Pal.*

Please call to begin the process of psychological evaluation, or to schedule an appointment: (248) 737-0388

Forty-eight (48)  hour cancellation required for therapy sessions.

Five (5) day cancellation required for all testing services. 

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