Christian Psychological Services

Psychological Services in Kansas City

Serving the Kansas City Area

Call 913-345-0033

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CPS New Client Information

Completing these forms will allow us to get to know you, and help us to help you. The Autobiographical Information Form will speed up the interview process in the first session or two. The Professional Services Agreement and the HIPAA forms are legal requirements which we must have before we can begin a professional relationship with you. The Insurance Information Form will help us check on your coverage, which we will do as a courtesy to you.

Please download and print out the forms, fill them out at your convenience, and bring them along to your first appointment with us. If you have any questions, please feel welcome to give us a call at (913) 345-0033.

If you cannot print out the forms at home, we have copies in the office which you can pick up, or we can mail them to you.
We look forward to working with you.

  • HIPAA Form – Click Here to Download
  • Professional Services Agreement Form – Click Here to Download
  • Insurance Information Form  – Click Here to Download
  • Confidential Adult Autobiographical Form – Click Here to Download
  • Confidential Adolescent Autobiographical Form – Click Here to Download
  • Confidential Child Autobiographical Form – Click Here to Download

Office Locations

Overland Park, Kansas
View Location Details

Suite 200 -
Keith Kobes, PhD &
David Pulcher, PhD

Suite 304 -
Charlotte Rosenak, PhD &
Marianna Finley, LMLP, LPC &
Kathy Nace, MA, LPC, NCC

Blue Springs, Missouri
View Location Details

 

Phone (all locations)
913-345-0033

Business Office Hours
10:00AM - 2:00PM - Mon - Thur

Clinic Hours
8:00AM - 8:00PM - Mon - Fri
8:00AM - 2:00PM - Sat
Clinic hours vary by therapist

2022 | All Rights Reserved

Christian Psychological Services of Kansas City
8575 West 110th Street
Overland Park, Kansas 66210

 

Suite 200 - Keith Kobes, PhD & David Pulcher, PhD
Suite 304 - Charlotte Rosenak, PhD & Marianna Finley, LMLP, LPC & Kathy Nace, MA, LPC, NCC