New Patient Forms must be submitted prior to scheduling all initial appointments.
Please note: KCPA providers DO NOT take insurance.
It is important to us that you understand the provider Visit Rates prior to completing the new patient forms.
Please visit Visit Rates page to learn more about the specific services that each of our professionals offers, and call if you have any questions.
CLICK HERE TO COMPLETE NEW PATIENT FORMS Online
Please allow 15 minutes to complete these forms.
Please contact Nathalie at 281-829-1599 with any questions or concerns about completing these forms.
In most cases I will contact you the same day, or the next business day after receiving the completed forms.
Office Admin hours are: Mon-Fri 11am-5pm
Alternate Print Option - If you need another method to complete forms please contact me at 281-829-1599
Release of Information Allows KCPA to share information with another provider.
Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.
Failure to show for your scheduled therapy or testing appointment, without at least 24 hours advance notice, will result in late cancelation/no-show fee equal to the full visit rate (1-hour) appointment, and $400 fee for each and any testing (2 or more hours) appointment.
By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.