• New Client Inquiry

  • Thank you for your interest in Counseling Centers of North Puget Sound.

    You may use this form to send us a message about a a possible new client appointment. We are happy to help you find the help that is right for you.

    All information entered into this form is securely transmitted and stored, for your protection. YOUR INFORMATION IS CONFIDENTIAL, except when we are required by law to disclose information. For more information, see our privacy policy. We NEVER sell your information to anyone.


    USING THIS FORM:

    *This is for non-emergency new client appointment requests. If you are contacting us about someone who is in need of immediate help, please contact your local crisis line or seek emergency assistance.


    ***More information is better. Especially regarding office locations and hours/days you are available/not available, ***

  • * If you are seeking an autism evaluation, or specifically wish to see Ann Uherek, PsyD, contact her directly at 206-729-2101.  

    We are unable to forward these requests to her.  

    thanks.

     

  • After we receive your request:

    * If you authorize us to send a detailed message via email, we will contact you to let you know when we have forwarded the information to providers who may meet your needs.

    * With the increased demand for mental health services that happened along with the pandemic, we are very busy. We cannot guarantee an opening that will meet your needs. For this reason, we encourage you to complete this form, but continue to search for a provider while you wait for a response from us.

    *If a provider has an opening that fits your needs, they will contact you directly within a week. Because we have been flooded with requests for new appointments, we are unable to respond to each individual request when we are unable to offer an appointment. So, if you do not hear back from us within a week, then we are unable to be of assistance.

    ***If you are able to be as flexible as possible with locations, type of provider, and scheduling, we are more likely to be able to find a match for you.***

  • CONTACT INFO:

    Please enter your information, even if you are contacting us about someone elese.
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    Pick a Date

  • You have chosen to restrict messaging from us.  That is your right to do so, and we respect that choice.  However, since we use email to let people know that we have taken action on your request, you will not receive this information.  

  • WHO ARE YOU CONTACTING US ABOUT?

  • CONCERNS:

    Please give us some information so we can find the best match.

  • SERVICES:

    *NOTE. We might be able to help with treatment that is court-ordered, but we do not provide court-related evaluations/reports of any kind (except to confirm attendance in treatment), chemical dependency evaluations or treatment, or formal anger management programs. In the case of parenting plan/custody disputes: We have very limited ability to provided counseling services for children in these situations. In this situation, a staff member will discuss the situation further with you to determine if we are able to accept the case. We are unable to provide any kind of evaluations, treatment reports, or recommendations for custody/parenting plan disputes.

  • NOTE ABOUT PSYCHOLOGICAL AND AUTISM SPECTRUM EVALUATIONS:  We have one provider who can provide these services:  Ann Uherek, PsyD. 

    Do not use this form for psychological evaluations.  Instead, contact her directly for more information.    206-729-2101

  • LOCATIONS:

  • SPECIAL COVID-19 ADVISORY:

    ** Many of our providers are working exclusively or primarily by telehealth (video conferencing, etc). If you do NOT wish us to consider telehealth as an option, then please say so in the Comments below. For in-person sessions, when available, we are paying close attention to hygeine and ventilation. Masks and COVID screening are required for in-person sessions.

     

  • APPOINTMENT PREFERENCES:

    IMPORTANT TIP: Later afternoon/evening appointments are often full. To ensure the best chance of finding a suitable match for your request, include as many options as possible for days and times that may work for your appointments.

  • FINANCIAL:

  • NOTES ABOUT INSURANCE:

    Acceptance of specific insurance plans varies by provider.

    *TRICARE MEMBERS: We do NOT have any providers who currently are contracted with TRICARE plans. However, we may have limited ability to accept TRICARE on an 'out-of-network' basis. Contact your TRICARE plan directly to determine if you have out of network benefits and what your cost share may be. Currently, we do not have any providers who work with Military One Source.

    *** MEDICARE and MEDICARE ADVANTAGE plans: We have a very limited ability to accept Medicare plans.  For Medicare Advantage plans, the clinician must be both a Medicare provider and eligible to bill the Advantage plan.

    MEDICAID AND MEDICARE? Unfortunately, because of the laws regarding these plans, we are unable to work with people who have BOTH plans under the QMB program.

    ****Affordable Care Act (ACA/Obamacare) subsidized plans: We may be able to accept your plan, but you should check with your insurance plan to verify that we are able to see you.

    PLANS WE DO NOT ACCEPT:

    • Veterans Administration plans, CHAMPVA, or VA Community Care plans.
    • All 'Provider One" Plans:
      • Labor and Industries (L&I)
      • Crime Victims Compensation (CVC),
      • Adoption Support, 
      • **Medicaid/Apple Health
      • Developmental Disabilties Administration (DDA)
    • Auto insurance or other non-health insurance plans*****

    *****Auto Insurance or other insurance plans: We generally do not accept these plans. However, we may be able to see you if your healthplan is accepted by the clinician, your healthplan is aware of the other insurance claims, and is willing to pay for your treatment (under a process called subrogation).

    FINANCIAL ASSISTANCE: We have a very limited capacity to provide financial assistance with the cost of care. If you need help paying for treatment, discuss this with your provider to see if it may be available for you.

  • EMPLOYEE ASSISTANCE PLAN (EAP) INFORMATION:

    Some people may choose to use an EAP plan to cover the initial sessions of counseling. It can result in savings for the client.  EAP's are only accepted by some of our clinicians, and the specific EAP plans accepted varies by clinician. 

    In order to use an EAP, it must be agreed upon with the clinician in advance.  We do not accept EAP plans for any sessions for which insurance has already been billed.  

  • PLEASE NOTE: As the pandemic has drawn on, increasing numbers of people are contacting us in need of help. We have been overwhelmed with the number of phone calls and emails requesting new appointments. We will do our best to respond as soon as possible.

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