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  • Family Restorations

    Restoring the  Soul of the Family for the Sake of the  Kingdom

  • Dr. Kendra Klassen, Psy.D.  ph. (949) 303-8933  mail. 23792 Rockfield Blvd. #290, Lake Forest, CA 92630

  • Personal Data

  • Please do your best to complete this form as accurately as possible. It takes about 20 minutes. There is room at the end for additional information. Please be aware that if you close the window this form opened in before clicking the "Submit form" button at the end, your data will be erased and you will need to start again. Thanks for your help in getting us off to a great start!

  • Contact information

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  • Marital Status

  • Children

  • Family History




  • Medical Information

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  • Medication

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  • Substance use

  • Prior therapy/counseling

  • Additional information

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