Kenfield Walters Intl 
Leadership Psychology

(248) 737-0388

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    • Home
    • Counseling
    • Psychological Evaluations
    • Child Custody Evaluations
    • Patient Forms
    • About Us
    • Contact Us

(248) 737-0388

Kenfield Walters Intl 
Leadership Psychology
  • Home
  • Counseling
  • Psychological Evaluations
  • Child Custody Evaluations
  • Patient Forms
  • About Us
  • Contact Us

PATIENT FORMS AND PAYMENT INFORMATION

INSTRUCTIONS FOR PAPERWORK

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. 

-

  • #6. Health Questionnaire Form - Complete - for all.

  • #5.  Telehealth Consent Form - for all. 

-

  • #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!!!

Downloads

KWI #7A. INTAKE ADULT FORM 2024 (docx)Download
KWI #7C. INTAKE CHILD FORM 2024 (docx)Download
KWI #6. HEALTH QUESTIONNAIRE 2024 (pdf)Download
KWI #5. TELEPSYCHOLOGY CONSENT FORM (docx)Download
KWI #8 HIPAA POLICY READ ONLY 2024 (docx)Download

  • Copyright 2022  Kenfield Walters Intl LLC All Rights Reserved 
  • https://www.apa.org/about/division/div40     www.apa.org  www.apa.org/action/science/performance  https://www.apa.org/action/careers/facts.pdf  https://www.apa.org/action/science/organizational  https://www.apa.org/action/careers/health/william-milberg locate information for Dr. Judith C. Walters at www.APA.org.  https://jobs.myflorida.com/go/Department-of-Business-and-Professional-Regulation/2815000

  

 KENFIELD WALTERS INTL LLC 

Judith C. Walters, PH.D., LP LICENSED CLINICAL PSYCHOLOGIST 


Psychological Evaluations - Office Ph.: (248) 737-0388 

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