Sally Kennedy, Ph.D.
Psychologist
  • Home
  • What Psychologists Do
  • How to Choose a Psychologist
  • Helpful Links
  • Insurance and Financing
  • Forms and Policies
Please submit all paperwork AT LEAST two days prior to your first appointment. Failure to do so will result in rescheduling, as I will need to verify your insurance benefits before the intake.

Please remember that YOU ARE RESPONSIBLE FOR ALL FEES that insurance will not cover.
​

Checklist for Forms
  • Please utilize this list to ensure that all forms are submitted to me prior to your appointment.
Checklist

New and Returning Patient Forms

Client Information Form
Billing Information
Request for Confidential Handling of Information

Policies and Practices

*UPDATED* 2017 Notice of Policies and Practices
Acknowledgement of Notice of Policies and Practices
Psychotherapy Treatment Agreement
Electronic Communication Policy

Fees

Fee Schedule

Releases of Information

  • Please review and sign any applicable Releases of Information below if you wish for me to submit claims to insurance of send statements to a second party.
Insurance Release of Information
Billing Release of Information
Web Hosting by iPage