New Patient Forms

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.


james

Dr. James Poysky PhD. Clinical Psychologist/Neuropsychologist.  Evaluations 

laurel

Dr. Laurel Casillas PsyD. Post-Doctoral Fellow, Supervised by James Poysky PhD.  Evaluations

alyssa

Alyssa Muchaw MA, LPC, NCC Counseling/Therapies   

Elizabeth Forman MA, LPC  Counseling/Therapies 

img

Sarah Joyner MA, LPC, NCC  Counseling/Therapies

yalda

Yalda Ahmadi M.Ed, LPC-Associate, Supervised by Tiffany Lindley 
Counseling/Therapies  


Confidentiality & Privacy Policy 

The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.

Exceptions include:

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.
Privacy Policy


Cancellation Policy

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.

281-829-1599 or [email protected]

Location

Administration Availability - (Clinician hours will differ)

Monday:

11:00 am-5:00 pm

Tuesday:

11:00 am-5:00 pm

Wednesday:

11:00 am-5:00 pm

Thursday:

11:00 am-5:00 pm

Friday:

11:00 am-5:00 pm

Saturday:

Closed

Sunday:

Closed