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: 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
Disclosure Statement: Morgan Boyd, LMHC, MHP
Disclosure Statement: Colette Swenson, M. Ed., LMHCA
Document: Telebehavioral Health Informed Consent (Click to View)
Please fill out the following information about your child:I am the parent/legal guardian of * Child's First Name* Child's Last Name* and agree to the terms on his/her behalf.