top of page
Stephanie Kugler, M.A., LPC
Forms
After you complete the online registration please also complete the forms below, you can email them to Stephanie before your appointment or bring completed to your first appointment.
Choose one of the following:
Client Information - Child/Adolescent
Client Information - Couples/Family
Complete all
Stephanie's Disclosure Statement
Consent to Communicate PHI Electronically
Complete if you would like me to speak to another professional (Physician, Teacher, Etc.)
Additional forms
bottom of page