Intake Form

Welcome to Kindred Heart Therapy Group's intake form.  Please fill out all sections of this form & submit it back to our team.  After we receive your form our team will review it and a clinician will reach out to schedule. 

 

Thank you, Kindred Heart Therapy Group, A Non-Profit Corporation!

You will receive a confirmation email once your online intake form has been successfully submitted.

If you are seeking additional services from our office please use this link.  A new tab will open with the form you need to complete to request those services.

If the client/child is under the age of 12 years old please answer the following:

Kindred Heart Therapy Group has multiple clinicians that offer a variety of service types.  The following questions are regarding client insurance information or payment preferences.

 

Kindred Heart Therapy Group accepts the following insurances: Anthem Medi-Cal, MHN Medi-Cal, Califorinia Health & Wellness Medi-Cal, Adventist Health, Partnership Health Plan, Carelon Commercial, Kaiser Medi-Cal, & several other insurances.  

 

We also offer private pay options, such as:

• Our Practicum clinicians are finishing graduate school and are able to provide services from $0 - $125 per session.
• Our Associate clinicians charge $90 - $150 per session.
• Our Licensed clinicians charge $125 & up per session.

Failure to provide accurate insurance information will void your intake form.  Please provide the name of all your insurance providers and your member ID #.

Failure to provide your available times for your intake session will void or delay your intake process.