PATIENT FORMS AND PAYMENT INFORMATION

ABOUT PAPERWORK AND PAYMENTS

PAPERWORK

DRIVER'S LICENSE AND/INSURANCE CARDS

• Copy both sides of your driver's license. Copy both sides of your insurance card(s), if applicable. Please do not use an iPhone to photograph paperwork. 

REQUIRED DOCUMENTS/DOWNLOADS BELOW:

• #7A. Adult Intake Form
  OR
• #7C. Child Intake Form if the patient is 17 years or younger. 

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• #6. Health Questionnaire Form - Complete - for all.
• 
  
• #5.  Telehealth Consent Form - for all. 

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• #8. HIPAA Document is a READ ONLY - Review - for all. 

CREATE CLEAR DOCUMENTS with

 www.PDFFILLER.COM or Adobe or other preferred applications.  Download links to desktop, upload to www.PDFFILLER.com . TYPE IN RESPONSES, CLOSE & SEND. EASY!!!

PAYMENT

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

• Sign up for Zelle® with your online bank account.
•  Go to "Transfer | Zelle®" at bank account page top. 
• 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 a counseling appointment: (248) 737-0388

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

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

USE PDFFILLER.COM  TO TYPE IN RESPONSES - EASY!!!