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Undivided Soul Counseling

Undivided Soul Counseling

Kathryn Katy Gelinas, LPC

  • About
    • Katy Gelinas LPC
    • Undivided Soul
  • Counseling
    • EMDR
    • Intensive Programs / Mini-Retreats
    • Telehealth Services
  • Professional Consultation
    • EMDR Certification
  • Training
  • Contact
    • Client Portal
    • Secure Messaging App
    • Forms
  • Resources

Forms

Here you will find PDF versions of some of my practice documents. If you opted not to use the Client Portal for intake, you may download applicable forms to print and fill out before your first appointment.

Intake Forms

Informed-consent-hipaa-privacy-notice-v.2023

Intake Questionnaire

Financial Agreement

Other Clinical Forms

Authorization for release of protected health information (“Release of Information” Form)

Consent for Telehealth Services

Contact

27 Siemon Company Dr Ste 315 W
Watertown, CT 06795
Phone 203-697-8983
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