Karie Thulon Klim, MA, MFTI 
Marriage & Family Therapy
Child, Adult, & Family

Forms

Dear Prospective Client,

The following forms are requested of all new clients. The forms are interactive for your word processing convenience.  Bring forms on this page with you to your consultation*  You are welcome to call me at (707) 888-0106 or email me (
karie@karieklim.com
) if you have questions. 

I look forward to meeting with you soon.

Very best wishes,

Karie


*Please do not eMail or text confidential information.


Choose the appropriate new client form, consent form, and Medications Record (if applicable).

Most forms are interactive. Download to your computer desktop, type your response, print form, and bring to you first appointment. 



DO NOT EMAIL FORMS TO ASSURE CONFIDENTIALITY.



 Please print and sign that you have read the 1) Treatment Agreement & Informed Consent and 2) HIPAA Notice of Privacy Practices. Bring with you to your consultation.

If you desire professional collaboration  (such as your doctor of psychiatrist), please fill out the Release of Information Consent Form and bring it with you to your appointment.
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