FORMS


FORMS
Kathy Dickinson Gray, M.A., NCC, LPC, LMFT, OTA,
EMDR Certified
Specialist in Sensory Processing/Self-regulation
Houston Eating Disorder Specialist
Certified IMAGO Relationship and Couples Therapy

*1525 Lakeville Drive, Suite 114
Kingwood, Texas 77339

*723 W. 17th St.
Houston, Texas 77008

*13706 N. Hwy 183 #114
Austin, Texas 78750

Phone: 281-223-3421
Email: kdgray8@gmail.com
kathygrayachievefulfillment.com 

Cancellation Policy
Appointments missed or cancelled with less than 24 hours notice will be charged at the full scheduled session fee. Please do not rely on email as sufficient notice for cancelling appointments. Be sure to give me a call or text.

I provide you with a Receipt For Service which you can then file with your insurance company to be directly reimbursed. My services are covered in part by most health insurance plans - I would be an "Out-of-Network Provider" on your plan. My credentials for coverage are Licensed Professional Counselor and Licensed Marriage & Family Therapist.

Informed Consent and Practice Policies for Office and Online Therapy

LITIGATION POLICY AND FEES FOR COURT-RELATED SERVICES

Emergency Care 

 RELEASE OF INFORMATION

Patient Intake Form