Forms
For  the 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.