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Green Hills with Blue Sky

Healing with Grace Counseling Center
702-716-0908
[email protected]

Kana Nootenboom
Clinical Director, LMFT
702-772-9552
[email protected]

2637 W. Horizon Ridge Pkwy
Suite 100, Henderson, NV 89052

Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

For Kana's Clients:

All Clients must fill out the psychotherapy intake and consent forms below:

Please print the following form with the above forms if client is a minor.

If you would like me to coordinate care with another provider  complete this form to authorize release of psychotherapy information:


For Clients of Kevel, Brian, Vanessa or Debbie

All Clients must fill out the psychotherapy intake and consent forms below:

Please print the following form with the above forms if client is a minor:

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

 

 


Note: To download Adobe Acrobat Reader for free, click here.

Schedule Appointment

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Helpful Forms

Click here to view and print forms for your appointment.

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