Resources
Professional Disclosure Statement
Please print, read, and sign for your first session with Priscilla Klockner
Child In-Take Form
This form is to be used for new clients under the age of 12.
Release of Health Information
Use this form to authorize release to, or from, Priscilla Klockner to a third party.
Good Faith Estimate Information
As of January 1, 2022 a new federal law called the No Surprise Act goes into effect. Under this law, all health care providers, including mental health therapists, need to give patients/clients who do not have insurance or choose not to use their insurance an estimate of the bill for medical items and services.