Shawna Kemp, LCSW
(904) 493-6116
P.O. Box 8904
Jacksonville, FL 32239
kempcounseling@yahoo.com
HELPFUL FORMS

If you're a new client, please complete the following forms and email, fax or bring them to your first session.  For virtual clients, all forms must be received at least 24 hours prior to your appointment.

  • Client Intake/Pre-Session Form
  • Limits of Confidentiality/Cancellation Policy Form

 

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

  • Consent to Release Information Form

Client Intake Form  
Confidentiality and Cancellation Policy  
Disclosure Authorization  

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