If you're a new client, please complete the following forms and bring them to your first therapy session

If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

If you would like me to coordinate care with a provider for TMS Therapy or Ketamine Therapy please complete the following forms below.

Mailing Address: P.O. Box 1611, Poulsbo, WA 98370

Fax: 360-697-2395


Or you can drop them off either at our Poulsbo or Silverdale offices.


If you have any questions please call us at 360-697-1141 or email:

• Front Street Clinic • P.O. Box 1611 Poulsbo, WA 98370 • Phone: 360-697-1141 • Fax: 360-697-2395 •