Forms

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

Client Psychotherapy Intake Form

Confidentiality And Cancellation Policy

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:

Authorization to Disclose Information Form

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

TMS Therapy Intake Forms

Ketamine Therapy Intake Forms

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:

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