Client Forms

Please print, fill out, and bring the appropriate modality intake form(s) to your first appointment. If using auto insurance coverage, please also print, fill out, and bring a Client Contractual Agreement and HIPPA Consent Form (call to inquire first).

Please print, fill out, and bring to your first appointment

If using insurance (limited to auto insurance), please contact me in advance and bring the following items to your first appointment –

For your use –

Catherine Patillo, LMT, NCTMB, CHt

contact@cathypatillo.com

801-864-4545

Professional Medical Office Building

2180 East 4500 South, Suite #135G
Holladay, Utah 84117