What to Expect

If you have already scheduled an appointment, you can help expedite the intake process by completing the forms in the list below. Please bring a photo id and a copy of your insurance card with you to your initial appointment. Please arrive about 15 minutes prior to your first appointment.

Intake Form (Adult)
Intake Form (Child / Adolescent)
Samaritan Fund Scholarship Application
Getting Acquainted Information and Disclosure Form
Financial Agreement
HIPAA Notice
Release of Information Consent Form
Consent to Provide VideoTherapy Services Form

We value your feedback! If you have received any services from Kilgore Samaritan Counseling Center please complete and submit the Client Satisfaction Survey below:

Client Satisfaction Survey Form