Katelyn braatz 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the CLIENT INFORMATION section. Enter your first name, middle name, last name, and contact details including your street address, city, state, zip code, cell phone, and email address. Select your sex and provide your birthdate.
3. In the IN CASE OF EMERGENCY section, list an emergency contact along with their relationship to you and their contact number. Indicate whether you permit them to be contacted regarding appointments or billing.
4. Complete the CLIENT INSURER / RESPONSIBLE PARTY section by providing the necessary information about your insurer or responsible party.
5. Fill out the CLIENT HEALTH QUESTIONNAIRE by checking the boxes that apply to you for each question regarding your mental health over the past two weeks.
6. Sign where indicated at the end of each section to confirm that all information is accurate and complete.

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