Call Now to Schedule: (904) 733-7333

Client Forms Copy

Client Forms Copy

You will need to fill out and submit new client forms prior to our first visit. Review of your therapy goals and any past experiences allows me to be better prepared for our visit. Please submit the forms to info@vijapura.com and we will contact you to set up an appointment.

 

Client Intake Form

Information Sheet

Limits of Confidentiality

Clear Mind Credit Card Authorization

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information





info@clearmindwithkelly.com
(904) 733-7333

Clear Thoughts
Clear Goals
Clear Minds


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