Intake Information

Policies

In order to best utilize my time, I have a 48 hour cancellation policy. If you cancel with late notice or miss your appointment, you will be billed a $100 missed appointment fee.

 

All applicable deductibles, co-pays and coinsurance are due at the time of service. Any remaining amounts will be invoiced monthly. If you are having difficulty paying your bill, please let my billing agent know promptly to arrange for a payment plan in order to avoid finance charges.

 

Forms

  • Intake Form – you can either complete and bring to your first appointment – OR plan to arrive 15 minutes early in order to complete them in the office
  • Release of Health Information – to enable me to share your clinical information with another provider, please download and complete this authorization form as well
  • Disclosure Statement – Disclosure of Information, Policies, and Client Agreement
  • Supervision Agreement – Agreement for my supervision services
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    Payment Options

Insurance

I accept all insurance plans and am a Preferred Provider with the following plans:

  • Regence Blue Shield
  • Premera
  • Blue Cross/ Blue Shield
  • First Choice Health Network
  • Aetna
  • United Behavioral Health
  • Group Health PPO
  • Cigna
  • MHN

We will bill your insurance directly or provide you with documentation for you to submit for reimbursement.

Please call to assess your benefits.

Private Pay

My private pay rate is $160/ hour for individuals, and family sessions. Each session is around 53 minutes. The initial evaluation session is slightly longer and more involved, and is billed at $190. I have a limited number of sliding scale spaces available for those demonstrating economic hardship.