Kennedy Consulting. Comprehensive Mental Health for all ages.











Kennedy Consulting
William D. Kennedy, Psy.D.

1550 West Main St.
PO Box 944
Wilmington, Ohio 45177

Ň(937) 383-3565
 (937) 383-0156

Kennedy Consulting ∑ 1550 West Main St.∑  (937)383-3565 ∑ Fax: (937)383-0156


Filling out forms at your physician's office isn't most people's idea of fun.

By giving you access to these forms at home, we're hoping to take at least a little stress out of your first visit to us, enabling you to print them and fill them out a bit at a time.


You will need Adobe Acrobat Reader© to access these files.
Download it free by clicking the following link:

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Adult Clients

Minors & their Parents or Guardians

Adult Clients Intake Form Child / Adolescent Intake Form
All New Clients
New Client Intake Form Video / Audio Consent
Financial Policy Form Release of Information
Treatment Consent Form  

We realize that this step takes a lot and work and time on your part. We do this because we know that you are in distress and want relief as soon as possible.  The completion of these forms allows us to help you reach your goals quickly and efficiently.

Itís important that you bring your insurance card and copay to your first session.  Contact your insurance company before the first session to get any authorization that you need and to find out what your mental health benefits are.  They may not be the same as your regular health benefits.  Insurance companies may not cover sessions that you have not requested authorization for in advance.


Kennedy Consulting ∑ 1550 West Main St. ∑ PO Box 944 Wilmington, OH 45177
Office: (937)383-3565 ∑ Fax: (937)383-0156 ∑ Email:

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