Many people like to talk on the phone a few minutes to see if we are a good match. Others find that they feel comfortable enough after reading my website to go ahead and schedule. Either way works for me.
You may want to check my current availability here before registering. Generally what you see on the calendar is what is available. Monday and Tuesday evening appointments are usually filled with existing clients and can only be scheduled by me through a phone conversation.
If our scheduling matches up, there are two steps to becoming a client.
Register as a new client here and then schedule your first appointment on line.
You will also be able to email me through a HIPPA compliant email system, which means all email messages are encrypted and confidential. You may also opt to email me through my regular email address as well, however, as you know, regular email is not encrypted and not necessarily confidential.
Please download and complete the forms below. Then print out, sign and bring to your initial session. This will save us valuable therapy time. There are 2 – 3 forms below depending on your situation.
Problem and Goals Form
Please download this form, save it on your computer, complete and then email back to me before your appointment. Couples: Each person needs to complete.
Microsoft Word document [36.5 KB]
Consents and Agreements Revised September 2014
Please download and complete these forms and bring them with you to our first session. You will also need to read all Policies before signing these forms.
Adobe Acrobat document [59.1 KB]
Policies & Privacy Practices Revised September 2014
Please read my Therapy Policies, Privacy Practices & Social Media Policy. When you sign the “Consents & Agreements” form you will be acknowledging that you have read, understand and agree to these policies.
Adobe Acrobat document [124.1 KB]
If you want to use Insurance – Forms
Although Compassionate Heart Couples Counseling primarily works with cash paying clients, Julie Kyker has contracts (HMO) with Anthem Blue Cross and Aetna Insurance. And, as an additional service to you we may be able to bill your insurance if you have a PPO plan.
Please contact your insurance company directly to find out if you are eligible for this service. The following form will give you the questions to ask your insurance company to find out what benefits you have if you want to use them for counseling with me. I recommend you complete this form and bring it in with you to our first appointment.
Insurance Information Form
This form will give you the questions to ask your insurance company so that you will have no financial surprises after your begin counseling. Please email completed form or bring to your first appt.
Microsoft Word document [33.5 KB]