If you are a new client, you will need to 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.

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

Individual Adults

  • New Client Paperwork 
  • 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.).
  • Upload Insurance CardIf planning to use insurance, please upload a picture of the front and the back of the card so we can verify your insurance before your appointment.

 

Couples Counseling Clients

  • Please have each partner fill out the below form.
  • Couples Client Paperwork
  • Upload Insurance CardIf planning to use insurance, please upload a picture of the front and the back of the card so we can verify your insurance before your appointment.

 

Children and Adolescents

  1. Review of Disclosure Statement – All clients must first review their counselor’s personalized disclosure statement and sign this form. Disclosure statements can be found here, in your counselor’s details.
  2. New Client Information – All clients must fill this out thoroughly with your most updated contact and insurance (if applicable) information.
  3. Appointment Policy – All clients must sign this statement which outlines our policies about cancellations and no-shows.
  4. Financial Policy – All clients, regardless of payment method, must sign this financial statement detailing our requirement of payment at time of service, and our policies on handling health insurance.
  5. Authorization for Primary Care Physician -All clients must sign this authorization either waiving, or permitting notification of protected health information to their primary care physician (PCP).
  6. Insurance ROI -All clients using health insurance as a form of payment must sign a release of information (ROI) to their health insurance provider.
  7. Upload Insurance Card-If planning to use insurance, please upload a picture of the front and the back of the card so we can verify your insurance before your appointment.
  8. General ROI-Children over the age of 13 may use this release to share some treatment information with their parent/legal guardian.
  9. Authorization for Reminder Services -*Clients who would like to receive email reminders of their appointments and phone messages must fill out this authorization.
  10. Therapy agreement between the parents/guardians of a minor and the therapist-All minors who are 12 and younger must have their parents sign this form.
  11. Therapy Agreement for Minors of Divorced/Separated Parents-All minors who are 12 and younger and parents are separated/divorced must have both parents sign this form.