509-579-0202

Forms

In order to best use our time, please download and complete the following forms to bring with you to your initial appointment.

In addition, please review my office policies on rates, appointment scheduling and insurance.

Intake Packet Forms

Demographic Information 

Consent For Treatment

Office Policies-Financial Agreement

HIPAA and WA St disclosures

AMEN

Adult intake questionnaire 

Couples

In addition, if you are planning couples therapy, please complete and bring the following forms with you as well.

Couple Screening Form – coming soon
Couple Satisfaction Form – coming soon
Individual Problem Checklist – coming soon

Spanish

Cuestionario Para Adultos
Amen Lista General De Sintomas de Adulto
Notas de Progreso