top of page

Client Forms

Client Intake Form​

​

  • Click the button above to find the client intake form for your first visit.

  • The form is a PDF fillable on the computer. You can complete and email back to: Kernanmpt@gmail.com or print it out, fill it out with pen and bring it the first visit.

  • Completing these forms prior to coming for your evaluation will allow more time to focus on understanding what your goals are, performing the exam, and develop a treatment plan. 

HIPAA Information

​

  • Above is a link to a copy of the HIPAA Privacy Rules. This is the Health Insurance Privacy Accountability Act of 1996. It is a detailed explanation of how your personally identifiable health information is safeguarded and protected as well as what your rights are related to your health records.

bottom of page