William P. Kooistra, Ph.D.
New Patient Forms
On this website, you can obtain three forms necessary for our work together. You can download these forms and complete them before coming to your first appointment, or you can wait and fill out copies of the forms in my office prior to your first session. Copies of the forms will be available in a folder on the table in my waiting room prior to your first session.
1. Patient Questionnaire – Please fill out this form as completely as possible.
2. Notice of Policies and Practices to Protect the Privacy of Patient Health Information -- This is a document that I am required by law to provide to you at the onset of treatment. It outlines the legal guidelines regarding confidentiality. You may review it online, make a copy for yourself, or wait and receive a copy at your first session.
3. Consent and Contact Agreements – Please complete this form. If you have any questions about it, please wait and discuss them with me prior to signing.
Client Information - Patient Questionnaire |
 |
|
Notice of Policies and Practices to Protect the Privacy of |
|
|
Consent and Contact Agreements |
|
|
Contact Dr. William P. Kooistra
41 Washington Avenue
Suite 365
Grand Haven, MI 49417
(616) 638-7557
drkooistra@gmail.com
The office is located on the third floor of the Harbourfront Place building - sometimes referred to as the "Piano Factory" - on the northeast corner of Washington Ave. and Harbor Dr. There is a large parking lot on the west side of the building. In the center of the building there is an elevator and a large stairway. On the third floor, turn left from the stairway (or right from the elevator) and pass through the double doors. Follow the long hallway to suite 365 - the fourth door on the right after the double doors.
Please consult the map below for the location of the building.