FORMS

After you have completed the needs assessment on the phone, please download and print these 4 forms and bring them completed to your first session.

Informed Consent

Informed Consent for Telehealth

rRelease of   Information

Rights & 
Responsibilities

Please call me at 608-347-1432 and leave a detailed message and a good time for me to return your call. 

​

I begin with all clients over the phone with a “needs assessment.” During this call, I learn more about your needs and intended outcomes for services.

 

Rate Breakdown:

  • The needs assessment by phone takes around 30 minutes and is free of charge. 

  • Rates for all services is dependent upon the scope of work requested.

​

You can pay via cash, check, or by clicking the "donate" button below (which allows you to pay with PayPal, or a credit/debit card.)

© 2019 by J Kushner. Proudly created with Wix.com