Forms and Links

Hi, y’all. Here are some forms and links. 

If you’d like to get a head start on your first appointment, download and fill out these forms: 

Informed Consent and Privacy Policy (You keep all but the last page, which you fill out and turn in, including whether or not you want animal-assisted therapy

Release of Information (for your physician(s) and any people you want to have information on your therapy. Print one per person you want to have information) 

ACE Survey (to get an idea of childhood experiences that have affected you)

For folks who are already in therapy:

DBT Diary Card (amended to work on a larger variety of issues) 

More Forms to Come

As people request specific resources in the comments on this page, I will add more forms and links where I can. All comments are moderated for the mental health of those reading. 

Some ideas:

More worksheets

Resources local to the Kansas City area

Resources for the entire United States

Acknowledgments and Links to Content: 

Thanks for dropping by.

Thank you to my family, friends, Patrons, and followers. A special shoutout (as always) to those who struggle every day and get up and keep going, every day.

Please support my work by signing up to be a Patron for a dollar or more a month or through dropping a tip at PayPal. Some of the other places you can find my work include on YouTube, SoundCloud, and the Out Of My Mind website.

If you want to see my rants and ramblings about process and politics, you can find them at my personal Facebook, my Twitter, and my Facebook page, Out Of My Mind.

You can go to its Facebook page to find out more about my therapy practice, Responsive Mental Health Services, LLC.

Finally, as always, half of every dollar I make from videos, podcasts, and writing (through PayPal or Patreon) is donated to my best friend, Katherine Malone.  She has a deadly heart condition and needs a heart transplant, but must raise $20,000 for anti-rejection drugs before she can be placed on the transplant list. You can find out more here and here, and go here to donate directly to her GoFundMe. This will continue until Kathy’s heart is fully funded.After that, half up to $500 a month will continue to be donated to assist her in paying for her anti-rejection meds.

A final reminder:  You are each important and have both much to teach, and much to learn. I look forward to learning from and teaching you all.

What are your ideas? 


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