Forms
Please print, complete and scan back to emergentcounseling@gmail.com the following form (confidentiality, consent & fee - see PDF below) prior to your first session. If you are not able to do so beforehand, we will spend the first few minutes of our time together filling in this form.
Confidentiality, Consent to Treatment & Fee Arrangement Form for Telehealth - Download PDF
Complete the Release of Information Form ONLY if you would like me to coordinate care with another provider (ie your previous therapist, psychiatrist or primary care physician, etc.). Please complete this form only for the purpose of authorizing release of information.
Release of Information - Download PDF
Insurances Accepted - See Contact page
Legal Disclosures
Professional Requirements
The RCW 18.19.060 and WAC 246‐810‐031 require counselors to provide written disclosure of the following information to clients before counseling begins. Therapists practicing counseling for a fee must be licensed with the State of Washington Department of Health, for the protection and safety of the public.
I am a licensed mental health counselor from the State of Washington and have earned a Master’s degree in Counseling Psychology.
Client Rights
I welcome any questions or concerns about treatment. If you believe that my conduct has been unprofessional as explained in the Department of Health brochure called "Counseling or Hypnotherapy Clients" then you may contact the Department of Licensing at (360) 236-4700.
The client retains the responsibility for making choices in the management of their life, including the choice of therapist and of whether to continue treatment in a particular counseling relationship. The course of treatment will be determined by mutual discussion between client and therapist. If you do decide to discontinue treatment, you are encouraged to discuss this with your therapist.