*Please note that filling out a New Client Form does not automatically schedule you with that practitioner. If you would like to schedule an initial appointment please call us at (360) 281-6824.*

 

If you are a new client, you must fill out all applicable forms in the following category before your first appointment. Please call us at (360) 281-6824 if you have any questions while reviewing your new client paperwork. These forms are not related to our Domestic Violence program. If you need an assessment, please contact the office.

Individual Adults:
  1. Please fill out these New Client Forms.
  2. Please also fill out this Release of Information if there is anybody you would like your therapist to have permission to speak to (examples: a past therapist, your medication prescriber, a partner that you want to be able to schedule appointments on your behalf, etc.).
  3. If planning to use insurance, please Upload your Insurance Card here, with a picture of the front and the back of the card so we can verify your insurance before your appointment.
  4. If you are planning on seeing one of our clinicians in person, please attach a clear copy/photo of your vaccination card and sign this waiver: Upload Vaccination Card, In-Person Waiver
     
Couples Counseling:

Couples Counseling: Please have each partner fill out the forms below.

  1. New Couples Client Forms
  2. If planning to use insurance, please Upload your Insurance Card here, with a picture of the front and the back of the card so we can verify your insurance before your appointment.
  3. If you are planning on seeing one of our clinicians in person, please attach a clear copy/photo of your vaccination card and sign this waiver: Upload Vaccination Card, In-Person Waiver
Adolescents Age 13-17 Years Old:

Children over the age of 13 are required to sign for themselves in accordance with Washington state law.

  1. This New Client Form for Adolescents is for the client to fill out and sign
  2. Please also fill out this Release of Information if there is anybody you would like your therapist to have permission to speak to (i.e., a past therapist, your medication prescriber, parent/guardian, etc.). 
  3. The Financially Responsible Party of the Adolescent’s Treatment will fill out this form.
  4. Please fill out the Therapy Agreement between Parents/Guardians of Minors and the Therapist
  5. Please also fill out this form if it applies to you, Therapy Agreement for Minors of Divorced/Separated Parents 
  6. If planning to use insurance, please Upload your Insurance Card here, with a picture of the front and the back of the card so we can verify your insurance before your appointment.
  7. If you are planning on seeing one of our clinicians in person, please attach a clear copy/photo of your vaccination card and sign this waiver: Upload Vaccination Card, In-Person Waiver
Children Age 12 and Under:
  1. These New Client Forms for Children should be filled by the client’s parent/legal guardian. If there are two legal guardians, both need to sign on the same form.
  2. Please also fill out this Release of Information if there is anybody you would like your therapist to have permission to speak to (examples: a past therapist, your medication prescriber, etc.).
  3. If planning to use insurance, please Upload your Insurance Card here, with a picture of the front and the back of the card so we can verify your insurance before your appointment.
  4. Please fill out the Therapy Agreement between the Parents/Guardians of Minors and the Therapist.
  5. Please also fill out this form if it applies to you, Therapy Agreement for Minors of Divorced/Separated Parents.
  6. If you are planning on seeing one of our clinicians in person, please attach a clear copy/photo of your vaccination card and sign this waiver: Upload Vaccination Card, appointment.
Additional New Client Forms:

If the clinic has requested you to fill out any additional forms, please fill out the requested form here.

  1. Insurance ROI
  2. Upload Insurance Card
  3. Therapy Agreement between Parents/Guardians of Minors and the Therapist
  4. Therapy Agreement for Minors of Divorced/Separated Parents
  5. Visitors to Treatment
  6. Video Consent Form
  7. Clinician Disclosure Statement