Medical Form – Self-Report
(TO BE COMPLETED BY PATIENTS)
Dear Patient – It is important that you provide us with your medical information in order to receive quality integrated treatment. Please complete the below form. If you would prefer to complete a hard copy of this form please print this form out or contact us at our secure email address, TheClinic@karenhorneyclinic.org if you would like a copy mailed to you with a self-addressed stamped envelope.