Bellevue Family Counseling
Child/Teen Therapy & Parent Coaching

1601 116th Ave NE, Ste. 102
Bellevue, WA  98004
425-417-5902

Print these forms and bring them to your first session.

How to Get Started

 

Forms

Please download, complete and sign the first three forms and bring them with you to the first appointment.  These are necessary for me to provide services.  If you have any questions, please feel free to email or bring your questions to our first session.

*If you are a new client, please email or call to confirm we have availabiity to see you or your child before booking an appointment.  

Forms    
Disclosure of policies agreement     
HIPAA notice of privacy & receipt    
New client questionnaire    
     
*Other forms - if requested by your therapist    
Parent Coaching Introductory Form    
Client release of information agreement    
Video release    
Court & Legals Fees - Posted for review      

 

Fees

We request payment upon completion of each session. Your insurance company may provide coverage for our services. Please check directly with them.  If you request, we will provide you with an invoice upon receipt of payment.

Rates: $130 per 50 min session. Longer sessions prorated.


We accept cash, checks, VISA/MC/Discover/American Express and Pay Pal.

Visa/MC Discover

 

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