Dr. Kriston A. Segura - Licensed Clinical Psychologist

New Patient Forms


If you're a new client, please complete the following forms and bring them to your first therapy session:
  • Client Intake Form
  • Confidentiality and Cancellation Policy Policy
  • Patient Data Sheet (Insurance Information)








If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, surgeon) or you are coming into therapy as a couple, complete the section in the intake packet labeled "authorization to release information".