Counseling Forms
These are the forms that are required to begin services.
If you are a new patient please choose either the adult packet for all persons 16 and over and child packet for all persons 16 and under.
Once you have completed these forms, please call us at 502.444.Life (5433) to complete the registration process and schedule your appointment.
When you call, please have your insurance card and credit card available.
Due to the high volume of registrations, we will not call you to complete the process.
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Our Fax number is 502.535.2618
Office Hours
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Monday through Thursday - 9 am until 4:30 pm
Friday - Closed
Saturday & Sunday - Closed
In order to be seen by our psychiatric mental health nurse practitioner (PMHNP) a referral must be submitted by your Life In Motion Therapist. You may complete these forms first but you can not schedule until we receive the therapist's referral.
If you are not an established patient with Life In Motion and are seeking to start psychiatric services you MUST also fill out the registration Intake Packet as well. Once all the forms have been completed, please call our office at 502.444.Life (5433) to have your referral generated by the front desk staff.
Once the forms are completed you must call the front desk to provide your insurance card and credit card before getting an appointment scheduled.
Due to the high volume of registrations, the front desk will not call you to complete the registration process or schedule your appointment.
Appointments are scheduled in the order we receive your calls and returned forms