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Forms

Welcome! I'm looking forward to working together. Please complete the forms below and send them to me via Spruce (learn more below) at least 24hrs. prior to your appointment time. These forms provide me with important information needed to tailor a treatment plan for your unique goals and outlines the expectations of client and therapist as we begin our work together.  

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Please note: for legal and ethical reasons, I am unable to begin our session until I have received your completed paperwork.  

Before Your First Appointment

New Client Forms Packet — all of the intake forms combined into one document for your convenience. For relationship/family therapy, please have each client fill out a packet.

Additional Forms (as needed)

I may ask you to fill out these additional forms based on your unique needs.

ART and EMDR Informed Consent and Agreement — If we are using ART (Accelerated Resolution Therapy) or EMDR (Eye Movement Desensitization and Reprocessing), please complete and return this form.

Medicare Private Pay (Opt Out) Contract — If you have Medicare, please complete this form to confirm your consent to use private pay therapy.

Reduced Fee Agreement — This form is for clients requesting a reduced fee based on need.

Release of Information Consent Form — I may ask you to fill out this form to collaborate with your other health providers in order to improve your treatment.

Updated Client Contact Information Form — If your contact information (or your emergency contact information) changes during the course of our work together, please complete and return this form.

Clients—Connect with me via

To enhance security and client privacy, I use the HIPAA-compliant platform Spruce, where we can securely exchange messages, photos, and documents. Available free to clients via mobile app, desktop app, and web browser.

Discover the areas I can help with and the types of therapy I offer, including details on what to expect in our work together.

Find everything you need before beginning therapy: fees & insurance, FAQ, location, online therapy, and contact form.

Explore tools and insights to support your growth—crisis support resources, library, helpful links, blog, and more.

Let's Connect

350 S. Main St., Suite, 306, Doylestown, PA 18901

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215-622-9628

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contact@kindredcounselingcenter.com

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By submitting this form via this web portal, you acknowledge and accept any risks of communicating your health information via unencrypted email and electronic messaging. You wish to continue despite those risks. By clicking "Yes, I want to submit this form," you agree to hold Meghan B. Jerry, MFT, LLC and Kindred Counseling Center harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic  means. Completing this contact form does not constitute a client/therapist relationship. 

Thank you! I look forward to connecting with you. If you haven't heard from me within 24 business hours, kindly check your spam email folder.

Want to learn more or ready to book a free 20-minute consultation? Let's connect.

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215-622-9628 | contact@kindredcounselingcenter.com​

350 S. Main St., Suite 306, Doylestown, PA 18901 | Doxy.me​​

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​​Individual Therapy, Relationship/Couples Therapy, Sex Therapy, Trauma Therapy, Accelerated Resolution Therapy (ART), EMDR Therapy, and therapy for enhancing self-worth and improving relationships in areas such as: self-discovery, communication, boundaries, intimacy, and healing from childhood wounds.

 

Available in-person in Doylestown, PA and online throughout Pennsylvania—from Pittsburgh to Philadelphia. Proudly serving all of Pennsylvania, the Greater Philadelphia area, and easily accessible to Buckingham, Chalfont, Gladwyne, New Hope, Newtown, Perkasie, Philadelphia, Quakertown, Solebury, and Warrington. 

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​© 2016–2025 Meghan B. Jerry, MFT, LLC as Kindred Counseling Center.  All rights reserved.

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This website and its content are for informational and educational purposes only and do not constitute a therapeutic relationship. The information provided is not a substitute for professional therapy, diagnosis, or treatment. Use all website content, worksheets, meditations, and external resources at your own discretion. Not responsible for external websites or resources. See Terms for details.

Disclaimer | Privacy Policy | Terms of Use

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If you're experiencing emotional distress, the resources below provide support. If this is an emergency, call 911.

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988 Suicide & Crisis Lifeline

Call 988 or 1.800.273.8255, Text HELLO to 988

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Crisis Text Line

Text HOME to 741741

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Additional Crisis Support Resources

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