(304)
346-9689

charleston
ravenswood
cabin creek
chapmanville

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Intake Forms

To download our Client Intake Forms, click here.

If you are bringing in a minor aged child, please download this form as well, click here.

HIPAA -- KPCC NOTICE OF PRIVACY PRACTICES  4-13-03.pdf

Release of Information Authorization Form.pdf

                             
                                    
                                      more than just a quiet presence for over 35 years
                                  and an accredited samaritan counseling center

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Call us at 304-346-9689 with questions or comments about counseling or about this web site.
Last modified: February 17, 2010  

KPCC, 16 Leon Sullivan Way, Charleston, WV 25301     304-346-9689      All rights reserved