Forms

This page lists various administrative and/or new patient forms that you may be asked to complete. Some documents are only for established patients and may not be available for download. Please contact KCCAT if you need a copy of one of these documents.

Before Your First Appointment

Before your first visit, you will be asked to complete some pre-evaluation paperwork (in addition to the New Patient/Resource Request Form you completed initially). Your assigned clinician will provide those documents to you upon scheduling. If you need another copy, please contact your clinician directly.

Your First Appointment

At your first appointment, also known as the initial assessment or evaluation, you'll be asked to review and sign some paperwork to make sure you are aware of our policies and consent to services at KCCAT. A copy of these forms will either be printed in your New Patient Folder or provided to you electronically.

Notice of Privacy Practices

You may view/download a copy of our current Notice of Privacy Practices. This document describes how medical information about you may be used and disclosed, and how you can get access to this information.

Records/Release of Information (ROI)

If we need to communicate or coordinate with someone else regarding your care (such as other providers outside of KCCAT, school personnel, employers, family members, etc.), you will be asked to complete an Authorization for Release of Protected Health Information, also known as an ROI. (If you are requesting records for your self or your minor child, please contact KCCAT for any necessary paperwork.)

Billing

KCCAT accepts payment by Visa, MasterCard, Discover, or American Express. (You may also pay by check, but we require a card as a backup payment method.) If you need to change your billing information or payment method, please contact KCCAT's administrative office.