Forms

1. Client Paperwork - Please print this client information and consent form, complete it, and bring it to your first appointment. If you do not have access to a printer, you can complete it at your first appointment. 
2. Office Policies and Disclosure Statement - Washington State law requires that I provide you with a copy of this document, which describes my background and training, my therapeutic approach, and the business aspects of my practice. Please read this information carefully and ask me to explain anything that you don’t understand. It serves as our agreement to our respective rights and responsibilities as therapist and client. A hard copy of this form will be provided to you at your request.
3. Notice of Privacy Practices ​- This document describes how medical information about you may be used and disclosed, and how you can get access to this information. I am required to give this notice to you under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). A hard copy of this form will be provided to you at your request.
4. Financial Agreement and Authorization for Treatment - Please fill out this form only if another person (e.g. a parent) will be responsible for your therapy bills. It should be read and signed by you and the person responsible for your payments. 
5. Telemental Health Consent and Authorization - Please fill out this form if you would like to be able to meet remotely via videoconferencing sessions.
6. Release of Information - Please fill out this form if you would like for me to receive or share information with someone else (e.g. another care provider, previous therapist, or any other person).