Forms

Forms to Download Before Your First Visit

Most of the Forms for SDC were created in collaboration with several other colleagues and my former counseling supervisor many years ago, and these are available for clients as well as clinicians to download. However, in transferring them to Google Docs, the formatting has been distorted (a common event when entering text on Mac OS at the time of this writing). Many pages have the signature portion on a second page, which needs to be included despite its brevity, just like any contract.

By downloading, printing, AND bringing the completed forms to your first visit, you will save yourself valuable time. If you do not bring completed forms to the first session, you will need to fill them out at the start of the session (this is state law). Please do not send them back to me as a separate Google document to my email.

You will also be given any additional forms as needed at the time of the visit. Also, if you are using an approved form of insurance that SDC takes (Regence, Premera, UMP, First Choice), please bring your insurance card to your visit, or copy BOTH sides of the card onto one side of an 8.5 x 11 sheet of white paper.

Client Registration Form (one per person or couple/family)

Treatment Program Statement

Counselor and Fee Disclosure Statement

Therapy Partner Electronic Payment Form (for credit/debit card processing)

Use of Electronic Transmission Form (for mobile phone, email, and Wi-Fi video conferencing sessions). You will not be able to download this form directly from this website, in order to maintain control and credit for its creation. Instead, I will receive your request for this form, and I will send it to the email you provide. Providers and HR: if you would like to discuss how you can create your own ETCF, please use my contact form to make a request.

In the office, you may also be given a HCFO form to sign and fill out, even though your insurance information will be submitted electronically; your initial form will remain on file.