Dr Kathy Allard

454 West Napa Street

Sonoma, CA, 95476

6506971717

Licensed Psychologist, Marriage & Family Therapist, and EMDR Practitioner

Licensed Psychologist

Dr Kathy Allard

Read & Complete Office Forms

BEFORE WE MEET

Please review and sign the office policies and forms at least two days prior to your appointment time. These explain my office procedures, and offer an agreement for psychotherapy services.

For your convenience, forms can be completed and signed online. If you prefer, you may also download PDFs and email the completed, required forms to psy@drkathyallard.com. I also ask that you download and complete the Credit Card Authorization PDF form to hold your appointment time. Please read my cancellation policy carefully.

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Forms

Please Complete

(Required)

2. Acknowledgement form
Download PDF

Acknowledgment Form Online Submission

Acknowledgment of Notifications

Your name on this form acts as a signature. By signing here, you indicate the following: I acknowledge the receipt of both Dr. Allard’s Office Policies and Agreement for Psychotherapy Services, and I understand and agree to comply with these policies. I understand that I may always request a hard copy from Dr. Allard, if needed. I understand that Kathy Allard, Ph.D., is a licensed psychologist (PSY16184) In the state of California.

Patient 1

First Name

Last Name

Date

YYYY

Patient 2

If applicable

First Name

Last Name

Date

YYYY

3. Credit Card Authorization**

Download PDF

** I ask for the the Credit Card Authorization form to hold your appointment time. For your security, the Credit Card Authorization is not filled out online. You can relay this information when we schedule your time on the phone, and bring your completed form with you to your first appointment.

Policies & Agreement for Services

Please Read

1. Office Policies & Agreement

Download PDF