Administrative Office
1116 Key Street, suite 204, Bellingham, WA 98225
Phone: 360-715-2488
Fax: 360-671-1842

 

Client Forms

We appreciate the time you are taking to fill out our paperwork. Please download the appropriate forms below and complete them by hand. Due to security and confidentiality issues, we have not made it possible for you to return these forms to us electronically. Please bring all of your completed forms to our office when you come for your appointment.

There are several forms to complete. If you are an adult seeking treatment for yourself, you will fill out:
the Adult Insurance Form,
the Adult Medical History Form,
the Adult Treatment Goals Form,
the Washington Notice Form,
and sign the Health Insurance Portability and Accountability Act (HIPAA).

If you are a minor or an adult seeking treatment for your minor child, you will fill out:
the Child Insurance Form,
the Child Intake Form,
the Washington Notice Form,
and sign the Health Insurance Portability and Accountability Act (HIPAA).