Attachment Center of Kansas

Helping Families Build Stronger Connections

Online Assessments

After purchasing an online assessment, complete this form.

Directions for setting up a first session
1.  To start services, click "schedule appointment online" on the home page.  On the scheduling page, click Services and select Diagnostic Interview.  A $65 deposit is required before your appointment will be scheduled.  When I receive notice of the appointment being scheduled, I will contact you by email.  

2.  Next complete the Billing Agreement on the child (Billing Agreements and intake forms for both the child and parent required for attachment and/or trauma assessments) and send through email or fax.  Once the Billing Agreement/s is received, you will receive an email confirming your appointment.  

3.  Once your appointment has been confirmed by me, download the Intake Summary, Consent for Treatment, Policies and Privacy Practices.  Complete the first 3 forms for each person who will be receiving services and email, fax or bring to the first session along with the insurance card/s.

These are fillable forms.  If you are unable to sign the document using a touch screen, scanned signature or some other source, I will have you sign the forms at the first session.
Child Intake Forms
Adult Intake Forms

Other Forms