Forms

Before our first meeting please print, read, complete, and sign the following forms as indicated on each form. The forms marked with an asterisk* below are required. The remaining forms are meant for your information.
Completing the forms in advance allows more time to address your concerns during our first visit.

• Intake Information*
• Intake Evaluation*
• Consent for Telehealth*
• Client-Therapist Agreement and Policies* 
• Good Faith Estimate for Psychotherapy Services*
• Notice of Privacy Practices Acknowledgement*
• Notice of Privacy Practices
• Disclosure Statement
• History of the Problem

If you are planning to meet virtually, please inquire with me about mailing via USPS. 

If you are planning to use insurance benefits, please bring your insurance card and have it ready for photocopying or mail a photocopy with your forms. 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.