Documents & Forms

KAREN S. KIRK, PhD / AITZA GALARZA, PhD / ASHLY CARPER, LCMHC

The following forms are for you to read prior to the first session. When you are scheduled, you will be guided to the patient portal to sign necessary documents. If we need information prior to the first session, you may be asked to download and print the Consent to Release Form. You can also send any questions to [email protected].

Informed Consent
Payment Policy
Privacy Practices
Telepsychology Consent
Consent to Release

ERIC L. HARTMAN, PsyD

The first two forms provide information to read prior to the initial session. Please bring the Intake Questionnaire and New Patient Information forms on the day of our first meeting, or fax in advance to 910-202-9289. You can also send any questions to [email protected].

HIPPA Notice
Telehealth Notice
Consent To Release
Intake Questionnaire
New Patient Information

JENNIFER K. COLEMAN, PhD

Print and bring completed forms to your next appointment or email forms to [email protected]

Authorization Form
Referral Form
Informed Consent