DR. KLENCK'S PATIENT INFORMATION

For your convenience our office forms are available for download to complete prior to your appointment with Dr. Klenck. Select either a Word document or PDF of each form based on your preference. PDF downloads will either initiate a download or open in a PDF web window depending on your operating system and web browser.

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PATIENT FORMS AVAILABLE FOR DOWNLOAD

Authorization to Share Information

Notice of Information Practices

Agreement for Services

Billing and Insurance Authorization

CANCELLATION POLICIES

The scheduling of an appointment involves the reservation of time specifically for you, so a minimum of 24 hour notice is required for re-scheduling or canceling an appointment. The full fee will be charged for sessions missed without such notification.

Suzanne Klenck, PH.D. | Clinical Psychologist