(920) 405-0917
rosemaryknapp@journeytoselfcounseling.com

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Client Forms

If you are new to therapy, please be sure to fill out the following forms, and bring them to your first session. This will help ease you into therapy, and allow as much time as possible to be spent focusing on you.

Client Contact Information Sheet

Client Intake

Authorization for Release of Information

 

Rosemary Knapp

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By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

 

Rosemary Knapp

Phone: (920) 405-0917

Email: rosemaryknapp@journeytoselfcounseling.com

 

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“Be faithful to that which exists within yourself.” – André Gide

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