PLEASE READ CAREFULLY: By signing below, I agree to begin therapy with Counseling West Seattle for the disclosed fee, and to pay deductible and/or co-pay portions at the beginning of each session. I understand that if insurance does not cover the entire amount, I am responsible for the full cost of my treatment.
CANCELLATIONS: If I am unable to keep a scheduled appointment for any reason, I must notify my provider at least 24 hours in advance or I will be charged the full amount for the allotted time.
Document: Privacy Practices (Click to View)
Disclosure Statement: Elliot Grossman, MSW, LICSW
Disclosure Statement: Ernie McGarry, MA, LMHC
Disclosure Statement: Stacey Goodrich, MA, LMHC
Disclosure Statement: Katie Unterreiner, MSW, LICSW
Disclosure Statement: Julea Gardener, MSW, LICSW
Disclosure Statement: Stefani Morris, Psy.D., Licensed Psychologist
Disclosure Statement: Gayle Zeller, LMHC
Disclosure Statement: Crystal Shipos, MS, LMHC, MHP
Disclosure Statement: Larisa Wendfeldt, MA, LMFT, MHP
Disclosure Statement: Aubrey Hardesty, Psy.D., LMHCA
Document: Telebehavioral Health Informed Consent (Click to View)
I am the parent/legal guardian of Child's First Name Child's Last Name and agree to the terms on his/her behalf.