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      • Individual counseling
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      • From Chaos to Calm
      • Preparing for the Jungle
      • Unguarded Minds Podcast
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  • Home
  • Services
    • About Me
    • Therapy in Colorado
    • Mental Health Coaching
    • Relationship counseling
    • Individual counseling
    • Yoga therapy
    • Judges and Lawyers
    • Forms
  • Resources
    • Blog
    • From Chaos to Calm
    • Preparing for the Jungle
    • Unguarded Minds Podcast
    • Learning Courses
    • Women Supporting Women

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FORMS

 My patient forms are offered online so that you can complete them in the  convenience of your own home or office.
 

Prior to our individual session, please download the forms below, fill in the  required information and bring them with you to our session. 

Forms

Intake Form (doc)

Download

Informed Consent for Telehealth (doc)

Download

HIPAA Signature Form (doc)

Download

HCFA (insurance billing form) (pdf)

Download

Release of Information (doc)

Download

Privacy Policy (pdf)

Download

Terms and Conditions (pdf)

Download

Service Agreement 2024 (pdf)

Download

Disclosure

Additional Information

Visiting and/or participating in this site and/or in correspondence with Tamara Kiekhaefer and/or in correspondence with any other professional entities represented herein in no way creates a patient/therapist relationship with Tamara Kiekhaefer and/or any other represented professional(s) on this site. This site is for entertainment purposes only. Information placed on the web may not always be complete, up-to-date, accurate, relevant, or applicable to all situations. Always double-check and confirm that any information you find on the internet is accurate, current, and complete in regard to your specific situation.

This web site and its agents make no promises, guarantees, representations, or warranties, expressed or implied, and assume no duty or liability with regard to the information contained herein and/or associated in any way therewith. No legal, counseling, or other professional services are being rendered and nothing is intended to provide such services or advice of any kind. The inclusion of external hyperlinks does not constitute endorsement, recommendation, or approval of those sites or their content. This web site (including the author of said website and articles) bears no responsibility for the accuracy, legality or content of the external sites or for that of subsequent links. Those who visit or use this web site, links, or any other information extracted from this web site assume all risks associated therewith.


“Women Supporting Women” ,“Preparing for the Jungle”, and "Overcoming Waves of Anxiety" are for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, mental-health professional, or other qualified health provider with any questions you may have regarding a medical condition. By participating in any way with this site or the Facebook pages and group, you are agreeing to let
Facebook, Tami Kiekhaefer, LCSW, "Women Supporting Women" ,"Overcoming Waves of Anxiety",and "Preparing for the Jungle" use your submissions in part, or in full in any capacity we choose.

Copyright © 2023 Healthy Healing - All Rights Reserved. 

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