Forms

First Session

Please print out each of the forms listed below, fill them out, and bring them with you to your first session.

• Client Information
• Professional Statement and Policies
• Notice of Privacy Practices
• Insurance Agreement

Other Forms

• Authorization to Release Information: This form is needed if you would like me to talk to your doctor, any other professional or family member about my work with you. A separate form is required for each person. You can either bring it with you to your next session, or fax it to my office at 425-286-6116.
• Credit Card Authorization:  Please fill out this form to pay your bill using either a Visa or MasterCard. You may fill this form out and fax it to my attention at 425-286-6116.  
• Request for Records: Please fill out this form if you would like to receive a copy of your records, or have them sent to another party. Records requests can take up to two weeks to process.