NEW CLIENT FORMS
If you're a new client, please carefully review and complete and/or sign the first 3 forms below and bring them to your first therapy session as I need these completed in order to see you that day. Please carefully review the Privacy Practices/ HIPAA Form and the RCW 18.130.180 Form; keep a copy of these forms for your records. If you are a couple, please each fill out a "Client Intake Form;" you can both sign just one Limits of Confidentiality/Therapy Cancellation Policy Form as well as a Disclosure Statement. Feel free to contact me with any questions, whatsoever, on any form that you review.
I appreciate your thoroughness in providing this information and bringing it with you to session. It will allow us to use our session time that day to focus on you. Thank you, in advance.
- Client Intake Form - fill out and bring with you
- Limits of Confidentiality/Cancellation Policy - sign and bring with you
- Disclosure Statement - sign and bring with you
- Client Notice of Privacy Practices - HIPAA - read and keep for your records
- State of Washington RCW 18.130.180 - read and keep for your records
Additionally, if you would like me to coordinate care with another provider (for example, your financial planner, estate planner, attorney, primary care physician, etc...), complete this form to authorize release of your protected health information:
Note: To download Adobe Acrobat Reader for free, click here.