All new KMHC clients must fill out our intake packet — all eight forms are linked below:

Keep in mind, not all of these forms have sections to fill out or sign, these are for your records should you want to print them out — please make sure to read everything, as important information such as your client rights is included.

Case Management Form

Client Information Form

Clients Rights

Consent to Release Information

HIPAA Notice of Privacy

Informed Consent

Patient Attestation

TeleHealth Consent Form

With COVID-19 impacting all appointments and moving us to a strict TeleHealth model, all new intakes must be completed in this online manner — if you have questions or need help, please call (502) 233-3030 for assistance.

*Client’s will sign with their mouse on a computer, or their finger on a smartphone or pad — if there is a space for a KMHC witness to sign, we will do so after the forms are submitted.

**IF YOU HAVE ISSUES WITH THE ABOVE ONLINE FORMS, OR IF THE FRONT OFFICE DIRECTS YOU TO USE DROPBOX, PLEASE CLICK HERE

Forms filled out via DropBox can be emailed to admin@kentuckymentalhealth.com, faxed to (502) 719-8161, or mailed to 5115 S. 3rd St. Louisville, KY 40214