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Kratochvil Health Kare

 

Michele R. Kratochvil MA, LMHC, NCC, LMT

Necessary Forms
Forms
Print out these forms and fill them out prior to your first session. 

 Bring these to your first appointment with any insurance information/authorization if you choose to utilize your insurance benefits.  It is your responsibility to know what your insurance coverage is.

The only page that is necessary for you to bring from the Informed Consent paperwork is the last page.  It has an emergency contact number and a place for your signature,  indicating that you have recieved this information
.
 

Document
CHILD AND ADOLSENT FORM
Document
ADULT INTAKE FORM

INFORMED CONSENT FORM


Client Satisfaction Survey

In order to evaluate my effectiveness and improve my clinical skills, it would help me a great deal if you would complete this questionnaire.  Your feedback is valuable to me.  Please do not sign your name.  This way you can feel free to be completely honest.  Please return via mail or fax.  Thank you.


BELOW IS A LINK TITLED "YOUR THOUGHTS".  

PLEASE FEEL FREE TO FILL IT OUT AND SHARE YOUR THOUGHTS.

THANKS FOR YOUR TIME.


Your Thoughts
Michele R. Kratochvil
120 Broadway Suite 304
Kissimmee, FL 34741-5706
Phone: (407) 870-2223
Fax: (407) 870-0035