Forms for download

Thank you for selecting our office for your mental health care. There are 5 forms that need to be filled out and mailed to our office along with a deposit check for $100 before we will schedule an appointment. When we receive this completed information and the $100 required deposit in our office, we will call you to schedule your first appointment.

If you have any questions, please feel free to give us a call at (425) 462-9511. This paperwork must be complete in all sections and your deposit check enclosed for us to call and schedule your appointment.

Note: All forms can be downloaded below as pdf documents. (If the files do not open on your computer, you are likely missing Adobe Acrobat Reader. This program can be downloaded for free at this link: Get Adobe Acrobat Reader)

Required forms:

	Patient Information
	Office Policy
	Missed Appointments Policy
	Notice of Privacy Practice Receipt
	Intake Data Form

Note: Click on the PDF icon to download a copy of the form

Optional Forms:

	School Report
	Release of Information --- It is important for our providers to be able to coordinate patient care with a primary care doctor, a therapist and/or your child's school. Please complete a release of information form for each specialist you would like our providers to coordinate care with. NOTE: If your child is 13 years of age or older, he/she must sign the release form per Washington State Law.

Note: Click on the PDF icon to download a copy of the form