Intake Paperwork

Please click here to print and fill out the intake paperwork and bring it with you along with your insurance card, if applicable. Disregard page two if you have insurance. Thank you!

501 Darby Creek Rd. Ste 50
Lexington, KY 40509
(859) 420-4224
Fax: (859) 263-8741
Email: lexingtontherapy@gmail.com

Hello, and thank you for allowing our office to help you with you.

It's with great pleasure that we welcome you to our clinical practice. Our goal is to treat you with the highest standard an outpatient office can deliver. If we don't meet that, please notify the office manager directly.

You have several rights as a patient. These include the right to know fees, ask questions, know the limitations of confidentiality, and to end service at any time. The paperwork, which follows will inform you of the limits of confidentiality and how your personal health information is used.

The paperwork must be complete in its entirety for the assessment and following therapy sessions to take place. Keeping your privacy is something we take very seriously. If you need assistance completing some questions, we will gladly assist you at your first session. We can assume no responsibility for your case until our first session occurs, which we look forward to.

Again, thank you for selecting our practice and allowing us to help. We look forward to providing the professional services you expect.


Kara Fresh
Owner, LMFT
www.lexingtontherapy.com or search Lexington Therapy, LLC on Facebook