Karie Thulon Klim, MA, LMFT, CBS
Psychotherapy & Biofeedback Stress-Relief Services
(707) 888-0106

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 OR VITAL STATISTICAL INFORMATION. 


PSYCHOTHERAPY NEW CLIENT FORMS

Most forms are interactive.  Please download, read, complete requested information, and sign the following documents and bring to the first appointment:
  • Adult New Client Contact & History or Initial New Child or Adolescent Contact & History Form, whichever is applicable
  • Treatment Agreement & Informed Consent
  • HIPAA Notice of Privacy Practices
  • HIPAA Acknowledgement of Receipt
  • Medications or over-the-counter medications

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. 

If you have a history of self-harm, suicidal ideation, or suicide see Safety/No Harm Contract form provided below.


 
BIOFEEDBACK NEW
CLIENT FORMS

New clients, please download, read, and sign Policies & Procedures and the Informed Consent. Download the Wellness Suggestions and follow the instructions for preparing for and taking care of yourself following your sessions.
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