Policies & Forms

Below is a list of the forms that will be reviewed and signed during the initial assessment. If you are able and comfortable doing so, please complete the Client Information Form and Client Checklist prior to your initial assessment..

Please visit the Connect Page to submit inquiries or requests.

Thank you!

Practice & Policy Forms:

Therapy Agreement
Client Rights
HIPAA Privacy Policies
Electronic Communication Agreement

New Client Intake Forms:

Initial Client Information Form
Symptom Checklist

Make A Payment Online:

PayPal: PayPal.Me/kennedylcsw
Venmo: @MelissaKennedyLCSW

As a reminder, I am not an emergency service. If you or someone you know is experiencing a life threatening emergency please call 911 or visit you local emergency room. If you need to contact the police, request a Crisis Intervention Team (CIT) officer.

In the event of a non life-threatening emergency, please contact me at 919.914.0072. If I am unable to answer your call, I will respond as soon as I am able to secure a private and confidential space to contact you. I would recommend these local crisis and emergency services if more urgent attention is needed.