New Client Intake


Estimated time to complete : 1-3 minutes

Congratulations in taking steps towards a healthier existence, and towards getting the support you need. Moving towards improvement begins with us getting to know your needs and your wants. The better we understand you, the better we can help you.

 WE ARE SORRY BUT WE CANNOT ACCEPT SAME DAY NEW APPOINTMENTS. This is because we have paperwork you must fill out prior to your first session. You also will need enough time to call your Insurance company and obtain your insurance benefits prior to your first appointment. You must receive a confirmation for your requested appointment time. Please do NOT show at our offices without receiving this confirmation from us via email.

*** Please note that if you plan to use health insurance you should come to your first visit with your current insurance benefit information checked and confirmed as you may have a deductible to meet before treatment is covered by your plan. Some services we provide may not be covered by insurance - please check with us if you are not sure.


 

What Services Are You Most Interested In?


 

Select the primary interest, even if you intend to engage in more than one service.

 

Note that not all clinicians may be available at all locations. Not all clinicians offer mobile or telemedicine (online sessions). Insurance may not cover online sessions. Additional fees may apply for mobile sessions.

 

 

We Need To Know Some Details About You To Set Up Your Chart


 

Note: An email address is required. The nature of email communication means confidentiality can not be guaranteed.

 

Note: In Washington state, children over the age of 13 are legally allowed to engage in their own self-directed mental health treatment without parental consent. (See Chapter 71.34 RCW) However, we fully encourage the participation of parents in their child's care.

 

Enter the gender listed on your birth certificate. If this does not match your birth certificate then your insurance claims will be denied and you will be responsible for the full amount due.

 


 


 

 

Will you be paying with insurance?


 

Enter the person's gender. If this is incorrect then your insurance claims will be denied and you will be responsible for the full amount due.
You will find this on your insurance card

KAISER CORE HMO

IMPORTANT!

Kaiser Core HMO has a specific requirement that, prior to your session, you MUST call them to have your session pre-authorized or they will deny your claim and you will be responsible for the full session fee. The call should take only a few minutes to complete. The number to call is;

1 - 888 - 901 - 4636

 


 

 

How did you hear about our services?


Help us discover the most effective ways to reach you. With your help, the funds we would have spent on ineffective marketing can instead be spent on improving services.

 


You MUST click the continue button below to proceed.