New Patient Forms

New Patient Forms must be submitted prior to scheduling all initial appointments.                                                                    
Katy Child Psychology providers do not take insurance.

It is important that you review the provider Visit Rates before filling out the new patient forms, which typically require about 15 minutes to complete. To learn more about our provider rates, please visit the Visit Rates page and feel free to reach out if you have any inquiries.


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 9am-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.

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]


Administration Availability - (Clinician hours will differ)


9:00 am-5:00 pm


9:00 am-5:00 pm


9:00 am-5:00 pm


9:00 am-5:00 pm


9:00 am-5:00 pm