Client Forms

Welcome to the Client Forms.

Some forms are fillable PDF and can be saved and just attached and few are scanned and uploaded via email. If you respond by attaching the documents to the email thread where I sent the forms, it will remain encrypted with the original password.

CLINICAL

Becoming My Patient

Client Service Agreement

Please read and sign the consent form signature page and return it to me at drleslie@protonmail.com

Client Intake Form

Please fill out the Intake form. If anything is irrelevant or which you cannot or choose not to answer just skip it. Please return it to me at least 48 hours prior to our first appt.

LABORATORY INSTRUCTIONS

Hair Sample Collection

CAREER COACHING/COUNSELING

Please fill out all 3 forms and return to me via email drleslie@protonmail.com

Becoming My Client

Client Service Agreement

Please read and sign the consent form signature page and return it to me at drleslie@protonmail.com

Client information Form

“I am so grateful to have had Dr. Korn share her wisdom with the GoodTherapy.org community. She has a wealth of knowledge in natural medicine and trauma and does extraordinary and admirable work here and abroad. Her continuing education presentation, ‘Rhythms of Recovery: Trauma Nature and the Body’ was a valuable resource for our members interested in non-pharmaceutical treatment methods. I encourage anyone interested in complementary and alternative medicine to familiarize themselves with Dr. Korn’s work, and I thank her for her wonderful contribution to our continuing education program." Noah Rubinstein, LMFT, CEO and Founder of GoodTherapy.org

Noah Rubinstein, LMFT, CEO and Founder of GoodTherapy.org
Leslie Korn is a terrific teacher. She is able to communicate her vast knowledge to her audience in a fun and dynamic way. Her positive energy and humor in combination with her ability to articulate complex ideas make her a wonderful speaker. We were lucky to have someone of Leslie’s caliber at our conference on Alternatives to Medication for Child and Adolescent Mental Health. Paula Ochs, LCSW, CP, PAT, Associate Clinical Director, Family Service League, Montclair, NJI

Paula Ochs, LCSW, CP, PAT, Associate Clinical Director, Family Service League, Montclair, NJI
Dr. Korn’s class took my clinical practice to another level. She goes beyond the traditional clinical considerations to helps practitioners guide their clients to better mental and physical health by implementing common sense nutritional strategies. This is the perfect training for any professional who wants to add nutritional awareness to help their clients improve their mood and their mental health. The mix of vignettes, knowledge sharing about the principles and practices of mental health and nutrition, charts, and recipes makes this course valuable and easy to follow. Jill Charney, MSW and yoga instructor, Boston

Jill Charney, MSW and yoga instructor, Boston
Dr. Leslie Korn has been my teacher, mentor, associate, and colleague for over thirty years. Leslie is a brilliant speaker, communicator, and a very skilled teacher who can take command of a class or group and move them to excellence. Leslie's teaching and speaking gift combines dynamism, clarity and a wonderful humor all rolled into one. She keeps her audience/students engaged, allows for critical thinking processes, motivates positive responses and creates an exciting learning environment. Dr. Mary Jo Ruggieri, Former Olympic synchronized swimming coach and professor, The Ohio State University

Dr. Mary Jo Ruggieri, Former Olympic synchronized swimming coach and professor, The Ohio State University
Leslie Korn used storytelling for her keynote “Somatic Empathy: Restoring Public Health with Massage.” Korn captivated attendees with stories of her work collaborating with tribal communities in Mexico and the United States to restore touch therapies and nutrition from traditional foods, traditions that had dropped off in response to complex and historical trauma. “Their bodies told stories their minds longed to keep quiet,” she said. Without breaking from her storytelling style, she fed the audience data from many studies, shared techniques for healing that were evidence-driven, and made recommendations for future studies. It was a rare treat that set the mood for the day, acknowledging the intangible nature of massage alongside the evidence. Diana Thompson, LMP, Seattle

Diana Thompson, LMP, Seattle
Leslie Korn really opened my eyes to micro aggressions and workplace issues, along with trauma and substance abuse. Maureen L., Counselor

Maureen L., Counselor
Lots of user friendly ideas for use with my clients from an excellent presenter with a wealth of clinical experience. One of the best presenters ever! Brian F., MFT, CA

Brian F., MFT, CA
Leslie is an excellent presenter with a vast fund of knowledge. I have listened to her before online and this was even better! Susan K., RN, CA

Susan K., RN, CA
Leslie has a beautiful voice. I truly enjoyed listening to her speak. Barbara T., Psychologist

Barbara T., Psychologist
The Multicultural Counseling Workbook provides and abundance of information about the cultural experiences of a variety or ethnic and other cultural groups, as well as practical exercises that encourage honest reflection, help identify assumptions and subconscious influences, while also challenging them to move beyond them. Some of the workbook's best moments are vignettes that show Dr. Korn's efforts to address sensitive topics, assess cultural influences and build therapeutic rapport with a variety of clients. I would recommend this workbook to mental health professionals seeking to increase their own as well as their client's cultural knowledge and self-awareness. Lambers Fisher, MS, LMFT, MDIV, Approved Supervisor, Minnesota Board of Behavioral Health

Lambers Fisher, MS, LMFT, MDIV, Approved Supervisor, Minnesota Board of Behavioral Health
The importance of multicultural competency in our conflict-ridden world can't be overstated. It is in everyone's best interest. But the work involved in disentangling one's prejudices is intense, and this book is here to help. Designed for clinicians and clients, there is something here for everyone. Estelle Disch, PhD, Professor Emerita of Sociology, University of Massachusetts, Boston

Estelle Disch, PhD, Professor Emerita of Sociology, University of Massachusetts, Boston
Dr. Korn's Multicultural Counseling Workbook is challenging, innovative, thought-provoking, educative, and experiential. All the qualities you want in an engaging workbook. When families and nations struggle behind unconscious masks of prejudice and bias, all efforts to heal illusions are welcome. The book is a valuable tool for nurturing change. Joseph Randolph Bowers, PhD, Senior Counseling Psychotherapist: Cultural, Indigenous, Disability, and Mental Health Specialist, University of New England, Australia

Joseph Randolph Bowers, PhD, Senior Counseling Psychotherapist: Cultural, Indigenous, Disability, and Mental Health Specialist, University of New England, Australia
As a university faculty member and clinical practitioner, I think Dr. Korn's book is a wonderful, comprehensive and much needed resource for cultural competency development. The narrative assists the reader in the exploration of one's personal cultural self-awareness and helps the acquisition of new skills. I found this workbook to be the best multicultural counseling field guide I've read in many years. It provides a thorough compilation of information, worksheets and exercises that clinicians will value for a long time to come. Dinah Manns, EdD, Research Lead/Faculty, Human Behavior-Couseling Studies, Capella University, Minneapolis, MN

Dinah Manns, EdD, Research Lead/Faculty, Human Behavior-Couseling Studies, Capella University, Minneapolis, MN
Leslie Korn has produced an impressive, highly accessible workbook on diversity and rapport building that will be of great benefit to counselors and professional help givers. Most importantly, it provides invaluable tools and exercises to facilitate better recognition, understanding and processing of feelings and beliefs regarding diversity in those of us who work in counseling. It is at the same time comprehensive and learned, yet highly readable with many case examples and illustrations. It is a gift to those who wish to be more adept in practicing in a more diversity-sensitive manner. John Ludgate, PhD, Author, Psychologist, Fellow of the Academy of Cognitive Therapy

John Ludgate, PhD, Author, Psychologist, Fellow of the Academy of Cognitive Therapy
A wise traditional birth attendant from Darfur once told that 'knowledge is like a garden: if it is not cultivated, it cannot be harvested.' Leslie's workbook is an effective fertilizer to cultivate multicultural counseling in the garden of clinical knowledge. It's a great resource for clinicians and healers to develop multicultural competencies and mindfulness to diversify their work. It can also be used as a 'refresher' for many kinds of helping professionals. Jakana Jayawickrama, PhD, Lecturer and Community Care Practitioner, University of York, United Kingdom

Jakana Jayawickrama, PhD, Lecturer and Community Care Practitioner, University of York, United Kingdom
A comprehensive, collaborative and insightful workbook, it offers the clinician opportunities to reflect on their personal cultural identity and socialization while encouraging a deeper understanding of the role of power, privilege, and the complexities of culture, ethnicity and race in other cultural communities. This workbook provides practical worksheets to help professionals moreover establish rapport and relationship with their clients. Dr. Korn's book is a gift to the field of mental health and will support culturally responsive professionals. Priscilla Sanville, PhD, Professor Emerita, Creative Arts in Learning and Social Justice Facilitator, Lesley University, Cambridge, MA

Priscilla Sanville, PhD, Professor Emerita, Creative Arts in Learning and Social Justice Facilitator, Lesley University, Cambridge, MA
The scope of Korn’s thinking and writing about the rhythms of recovery is remarkable. She has personally trained in many of the modalities she covers and fully respects the need for therapists to have excellent preparation and training in these modalities. I don’t underestimate the difficulties involved in training and practicing integrative approaches to therapy, yet I believe that Korn’s book should be used in all psychotherapy training, followed by actual hands-on training, for the emerging generation of therapists.
This book broadens contemporary understandings of trauma beyond the current confines of academic discourse to complex real-world issues of culture and spirit. I strongly recommend this book as an essential resource and guide for clinicians and their patients who have experienced trauma. James Lake, Psychiatric Times

James Lake, Psychiatric Times
As a psychologist and dance movement therapist, I am happy to see Leslie Korn’s book Rhythms of Recovery: Trauma, Nature, and the Body, appropriate for people who have experienced trauma as well as for therapists working with trauma victims. Most books on trauma are one-dimensional; they may deal with emotions and cognitions but leave out consideration of the body. Or they may deal with the body but leave out consideration of the environment around the body or omit a broad cultural context. Korn’s book manages to integrate psyche, soma, and spirit as well as nature, physiology, and culture through the theme of rhythm. Ilene Serlin, PsycCRITIQUES

Ilene Serlin, PsycCRITIQUES
All emotional disorders are the result of trauma, mostly from in utero through the first 7 years of life. The modern uncivilized practices of unlimited wars and repeated forceful immersion of soldiers in barbarian trauma has produced an epidemic of PTSD. Rhythms of Recovery offers a road out of the insanity. C. Norman Shealy, MD, PhD, president, Holos Institutes of Health and president emeritus of Holos University Graduate Seminary

C. Norman Shealy, MD, PhD, president, Holos Institutes of Health and president emeritus of Holos University Graduate Seminary
Rhythms of Recovery masterfully weaves the history of medicine as it relates to trauma and gender with ancient and contemporary interventions using the power of touch. Thoroughly researched, this book offers an integrated approach to treating trauma, and its therapeutic protocols and interventions advance a holistic approach to treating trauma. Patrisia Gonzales, PhD, author of Red Medicine: Traditional Indigenous Rites of Birthing and Healing

Patrisia Gonzales, PhD, author of Red Medicine: Traditional Indigenous Rites of Birthing and Healing
The longer we study the effects of traumatization, the more we see the impact on the body. Leslie Korn shows us how the body operates rhythmically, how trauma disrupts that rhythmic functioning and, most importantly, how a plethora of new (and old) methods can be used to help the body restore its balance. This book is a must read for every therapist who deals with trauma. Don R. Catherall, PhD, professor of clinical psychiatry and behavioral sciences at Northwestern University and author of the Handbook of Stress, Trauma, and the Family

Don R. Catherall, PhD, professor of clinical psychiatry and behavioral sciences at Northwestern University and author of the Handbook of Stress, Trauma, and the Family
Rhythms of Recovery is brilliant and comprehensive. Integrating work from numerous disciplines, Dr. Korn brings profound insight into the impact of trauma and the body. She guides us in listening to voice of the body and provides extraordinary guidance with practical and alternative forms for health and healing. This is a long awaited and needed book―amazing work! Lisa Machoian, EdD, author of The Disappearing Girl: Learning the Language of Teenage Depression and senior consultant at the Trauma Center at Justice Resource Institute

Lisa Machoian, EdD, author of The Disappearing Girl: Learning the Language of Teenage Depression and senior consultant at the Trauma Center at Justice Resource Institute
It is one thing to say that Descartes mistook the body and the mind for two different ontological substances. Putting the body (including the brain) and the mind together again, and regarding them as expressions of one substance, is a much more demanding matter. Still, trauma experts become ever more convinced that the consequences of severe neglect, abuse or still other horrors affect individuals at the level of the whole organism. Leslie Korn is certainly one of them. In this intriguing book she thus addresses the whole person, clinically, empirically, and therapeutically. I highly recommend trauma therapists to test the integrative path to understanding and healing she invites us to tread.

Ellert Nijenhuis, PhD, coauthor of The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization
In this phenomenal book, Leslie Korn explores ever-more important processes of self-regulation and offers insights of great practical―as well as philosophical―value. Leon Chaitow, ND, DO, honorary fellow, University of Westminster, London, and editor-in-chief of the Journal of Bodywork & Movement Therapies

Leon Chaitow, ND, DO, honorary fellow, University of Westminster, London, and editor-in-chief of the Journal of Bodywork & Movement Therapies
In Rhythms of Recovery, Leslie Korn provides a unique review of the historical and cultural roots of trauma. She forcefully endorses the role of the body in defining the traumatic experience, and its essential inclusion in the healing process. Finally, Korn presents a thorough review of behavioral, somatic and nutritional avenues to healing. Her depth of knowledge, clarity of presentation and rich fund of supportive references make this a unique contribution to the literature addressing the understanding and healing of trauma. Robert C. Scaer, MD, author of The Body Bears the Burden and The Trauma Spectrum

Robert C. Scaer, MD, author of The Body Bears the Burden and The Trauma Spectrum
Rhythms of Recovery: Trauma, Nature, and the Body is the first scholarly work that attempts to fill the enormous gap in the conventional armamentarium used to treat PTSD. Dr Korn’s clinical work in rural Mexico and academic training at Harvard eminently qualify her to unite the complex threads of conventional and alternative therapies into a compelling tapestry of therapies addressing the complex social, psychological, cultural, biological, and energetic causes and meanings of traumatic experience. Her book will be received with welcome relief by trauma therapists and their patients who have grown weary of the limited narrative of conventional care. James Lake , MD, Psychiatrist, Integrative Medicine, APA

James Lake , MD, Psychiatrist, Integrative Medicine, APA
Dr. Korn expertly guides readers to understand the complex―and fundamental―relationship between diet and mental well-being. This essential book will prepare clinicians to more effectively and holistically support their clients' mental health. Dr. Tabatha Parker, Education Director of the Academy of Integrative Health & Medicine; Professor, Global Health Masters, National College of Natural

Dr. Tabatha Parker, Education Director of the Academy of Integrative Health & Medicine; Professor, Global Health Masters, National College of Natural
A must-read guidebook for patients and practitioners. This comprehensive mental health care resource illuminates the landscape of nutrition, including the latest research on the gut-brain connection, the role food intolerances can play in disrupting the nervous system, supplement guidelines, and powerful food-as-medicine strategies. Kathie Madonna Swift, MS, RDN, LDN, FAND, author of The Swift Diet

Kathie Madonna Swift, MS, RDN, LDN, FAND, author of The Swift Diet
Nutrition Essentials for Mental Health is an absolute must-read for all mental health professionals, and highly recommended for anyone wanting to understand the connection between what we eat and how our minds function. Dr. Korn brings two crucial concepts to the table: the importance of the diet of our ancestors and the significance of biochemical individuality. This book will change lives! Gray L. Graham, BA, NTP, President and Founder of the Nutritional Therapy Association

Gray L. Graham, BA, NTP, President and Founder of the Nutritional Therapy Association
Leslie Korn has written the essential book for mental health care providers. As I read Nutrition Essentials for Mental Health, I was astonished at the level of detail. It is engagingly written and fascinatingly encyclopedic in its reach. The delicious recipes alone provide a pathway to health. This book should be a bible for the mental health field. Peggy Knickerbocker, James Beard Award-winning cookbook author

Peggy Knickerbocker, James Beard Award-winning cookbook author
[A] complete and highly usable guide to the landscape of nutrition and the mind-body connection that the student, clinician and patient alike can connect to and learn from. . . . [A]s a patient who suffered from the nutritional deficiencies and medical issues as well as the mental health concerns described, I would have greatly benefited from this book during my illness. . . . As compared to other texts, [this book] is written in a more accessible tone for those without an extensive background in medicine and psychology; it also strikes me as a more beneficial resource due to the appendices, which are packed with recipes, charts of nutrients and their impacts, and the detailed examples of treatment plans that show the harmony of nutritional therapy when treating everything from seasonal affective disorder to schizophrenia. PsychCentral

PsychCentral
A] much needed addition to the field of mental health. . . . Though the book is written by and for clinicians, clients and those interested in nutrition will also find this book accessible. Chapter three is particularly helpful for therapists, as it includes a clinician checklist, food journals, and sample dialogue with a client for those new to addressing nutrition in a clinical counseling session. This easy-to-read guide is an invaluable resource for mental health professionals and is highly recommended. American Reference Books Annual

American Reference Books Annual
There are excellent case scenarios, question/answer sections, recipes, and activities throughout the book . . . . [A]ny healthcare professional with a thorough understanding of anatomy and physiology will benefit from reading the book and learning how food and nutritional deficiencies can negatively affect a person’s mood, mental health, and physical health. Metapsychology Online Reviews

Metapsychology Online Reviews
To say this book is a complete guide is an understatement . . . Dr. Korn manages to offer every imaginable support one needs from peer-reviewed data validating her assertions to sample dialogues, case vignettes, goal setting procedures and essential outcomes. . . . The Appendices are a treasure trove in themselves with comprehensive resources, guidelines, recipes, a sample client intake form, food-mood diary, and lists of foods containing gluten, lactose, casein, dairy, corn and oh so much more. There’s no doubt in my mind that this is the go-to textbook for clinicians wanting to bring awareness to food and its impact on their clients’ mental health. . . . [T]his isn’t the kind of book you read once and set on the shelf; rather, it’s a companion to reference throughout the day working with clients, listening to friends and hearing your own body speak. Somatic Psychotherapy Today

Somatic Psychotherapy Today
Nutrition Essentials for Mental Health is a textbook, a protocol guide, a cookbook, and a resource guide all-in-one, with many appendices and charts that will easily become a go-to reference for integrative health practitioners of all disciplines treating clients with mental health conditions. . . . Korn has done a tremendous job of assimilating medical nutritional information from across many cultures and traditional practices. All ages are covered, with many suggestions on how to make nutrition fun for children and adults alike. . . . Her approach is gentle and encouraging . . . without being overwhelming or discouraging to the client. The Townsend Letter

The Townsend Letter
Your book is amazing. What a great resource for nutritional advice that is directly accessible to patients struggling with cognitive and mental health issues. Love the tables and diet reviews. All evidence based. Love, love it. We've been waiting for a resource like this for a long time. Kabran Chapek, ND, Naturopathic Physician at Amen Clinics Northwest

Kabran Chapek, ND, Naturopathic Physician at Amen Clinics Northwest
If there is one book that I would recommend for mental health professionals to use when discussing dietary changes with their clients, this is it. It covers every conceivable aspect of the interaction between diet and mental health, and synthesizes all of the leading research into a highly readable text. Lila Elizabeth Massoumi, MD, ABIHM, Chair of the APA Caucus on Complementary, Alternative, & Integrative Medicine

Lila Elizabeth Massoumi, MD, ABIHM, Chair of the APA Caucus on Complementary, Alternative, & Integrative Medicine
I highly recommend this book to any professional or clinician working in the mental health field, as it will provide an invaluable resource for their patients. Korn's unique ability to articulate a collaborative approach toward compassionate mental health care is refreshing. With years of clinical experience supported by decades of evidence-based research, her book enables clinicians to help their patients understand the underlying biological processes driving their mood and behavior and make the necessary changes to restore balance. James M. Greenblatt, MD, Integrative Psychiatrist, Editor of Integrative Therapies for Depression

James M. Greenblatt, MD, Integrative Psychiatrist, Editor of Integrative Therapies for Depression
If you are looking for vibrant speaker and educator who assists you in applying integrative approaches while thinking both within and outside the box – look no further. Leslie Korn provides the full spectrum of medicine traditions, with applications to public health and clinical service. Leslie is one of the finest speakers and clinicians I have had the opportunity to train with and learn from. Her understanding of trauma, culture and the development of health is like none other. Leslie’s narrative engages audiences fully, meeting the unique needs of each group. Add to this, her integrity and ethics, with a dose of vibrant humor, her lectures and courses become everlasting. Her blend of gold standard research and a life time of clinical and cultural experience brings a unique understanding of the human condition, along with practical application of health principles in a variety of communities. Leslie shares her passion for health, vitality and the journey one takes to wellness. Every moment with her is worth its weight well beyond measure. Sandi Loytomaki, Integrative Medicine Practitioner Student, M.OMSc Osteopathic Manual Therapy, Toronto, Ontario, Canada

Sandi Loytomaki, Integrative Medicine Practitioner Student, M.OMSc Osteopathic Manual Therapy, Toronto, Ontario, Canada

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Testimonials

Noah Rubinstein, LMFT, CEO and Founder of GoodTherapy.org

Paula Ochs, LCSW, CP, PAT, Associate Clinical Director, Family Service League, Montclair, NJI

Jill Charney, MSW and yoga instructor, Boston

Dr. Mary Jo Ruggieri, Former Olympic synchronized swimming coach and professor, The Ohio State University

Diana Thompson, LMP, Seattle

Maureen L., Counselor

Brian F., MFT, CA

Susan K., RN, CA

Barbara T., Psychologist

Lambers Fisher, MS, LMFT, MDIV, Approved Supervisor, Minnesota Board of Behavioral Health

Estelle Disch, PhD, Professor Emerita of Sociology, University of Massachusetts, Boston

Joseph Randolph Bowers, PhD, Senior Counseling Psychotherapist: Cultural, Indigenous, Disability, and Mental Health Specialist, University of New England, Australia

Dinah Manns, EdD, Research Lead/Faculty, Human Behavior-Couseling Studies, Capella University, Minneapolis, MN

John Ludgate, PhD, Author, Psychologist, Fellow of the Academy of Cognitive Therapy

Jakana Jayawickrama, PhD, Lecturer and Community Care Practitioner, University of York, United Kingdom

Priscilla Sanville, PhD, Professor Emerita, Creative Arts in Learning and Social Justice Facilitator, Lesley University, Cambridge, MA

James Lake, Psychiatric Times

Ilene Serlin, PsycCRITIQUES

C. Norman Shealy, MD, PhD, president, Holos Institutes of Health and president emeritus of Holos University Graduate Seminary

Patrisia Gonzales, PhD, author of Red Medicine: Traditional Indigenous Rites of Birthing and Healing

Don R. Catherall, PhD, professor of clinical psychiatry and behavioral sciences at Northwestern University and author of the Handbook of Stress, Trauma, and the Family

Lisa Machoian, EdD, author of The Disappearing Girl: Learning the Language of Teenage Depression and senior consultant at the Trauma Center at Justice Resource Institute

Ellert Nijenhuis, PhD, coauthor of The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization

Leon Chaitow, ND, DO, honorary fellow, University of Westminster, London, and editor-in-chief of the Journal of Bodywork & Movement Therapies

Robert C. Scaer, MD, author of The Body Bears the Burden and The Trauma Spectrum

James Lake , MD, Psychiatrist, Integrative Medicine, APA

Dr. Tabatha Parker, Education Director of the Academy of Integrative Health & Medicine; Professor, Global Health Masters, National College of Natural

Kathie Madonna Swift, MS, RDN, LDN, FAND, author of The Swift Diet

Gray L. Graham, BA, NTP, President and Founder of the Nutritional Therapy Association

Peggy Knickerbocker, James Beard Award-winning cookbook author

PsychCentral

American Reference Books Annual

Metapsychology Online Reviews

Somatic Psychotherapy Today

The Townsend Letter

Kabran Chapek, ND, Naturopathic Physician at Amen Clinics Northwest

Lila Elizabeth Massoumi, MD, ABIHM, Chair of the APA Caucus on Complementary, Alternative, & Integrative Medicine

James M. Greenblatt, MD, Integrative Psychiatrist, Editor of Integrative Therapies for Depression

Sandi Loytomaki, Integrative Medicine Practitioner Student, M.OMSc Osteopathic Manual Therapy, Toronto, Ontario, Canada