Craig P Kurtz LMHC, PA
Patient Forms
New patients will need to fill out several forms before therapy can begin.
Please complete the following documentation and select the best method
Please return the completed documents to our practice either in person, by fax or as a scanned PDF file via e-mail. Naturally, all forms are also available at the practice; however, filling them
out in advance saves time.
If you are unsure which forms to fill out, don't hesitate to contact us at
craig@craigkurtz.com or (904) 215-5282
Please complete and return these forms via email - scan after signing
consent forms
forms for email.docx
Microsoft Word document [20.9 KB]
consent forms
forms for email.docx
Microsoft Word document [20.9 KB]
Telehealth Consent
Please review and print and sign the informed consent form for Telehealth
CONSENT FORM FOR TELEMENTAL HEALTH SERVI[...]
Microsoft Word document [14.8 KB]
Please review and print and sign the informed consent form for Telehealth
CONSENT FORM FOR TELEMENTAL HEALTH SERVI[...]
Microsoft Word document [14.8 KB]
Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.
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