About Me   

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Forms   

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Forms to be reviewed, completed and signed by Everyone

• Intake Information
• Consent for Telehealth
• Therapist Agreement and Policies
• Notice of Privacy Practices
• Notice of Privacy Practices Acknowledgement
• Disclosure Statement

Form to be completed by Individual Adults, Teens or Couples

• Intake Evaluation

Forms to be completed by parents seeking therapy for their teen girl

• Developmental History Questionnaire
• History of the Problem

Please bring your completed forms with you to our first meeting. If you are planning to use insurance benefits, please bring your insurance card and have it ready for photocopying. I am a contracted provider with Premera, including any of its Blue Cross Blue Shield affiliates. Please check with your insurance benefits representative about your particular plan and any out of network coverage you may have.