Thank you for choosing Untangle Psychotherapy. If you have scheduled an initial appointment with me by phone or email, please take a minute to read through and fill in the following documents in order to expedite our first meeting. I look forward to seeing you!

If you are looking for a new therapist, or to get more information, but have not yet scheduled an appointment with me, please use the Contact page to get in touch. 


Consent and Disclosure Packet

In anticipation of our first meeting, please download this Consent and Disclosure Packet, which will give you some more information about me and my practice, as well as provide important information about confidentiality and your consent to therapy. For our initial appointment, please print, sign, and date two copies of the final page of this packet.


New Client Information

Please fill in this form, which will help to give me some basic information about you. If you would prefer to download, print, and fill in this form, you may do so here.

Name *
Name
Preferred name (if different from legal/given name above)
Preferred name (if different from legal/given name above)
Date of birth *
Date of birth
Contact Information
Phone *
Phone
Message preference *
Mailing address *
Mailing address
Demographic Information
Pronouns *
If you are a student, please note your school, year, and major if applicable
(e.g. web search, Psychology Today, referral from a friend, or another provider)
Emergency Contact Information
Name of emergency contact *
Name of emergency contact
Phone number *
Phone number

Rights and Responsibilities of Counselors and Clients

Lastly, please review this pamphlet from the Washington State Department, which outlines your rights and responsibilities as a client. Please note this is just for your information and does not require any signature.


Electronic Payment

Payment is due at the time of session, and I accept cash or check, as well as electronic forms of payment such as credit and debit cards. If you would prefer to pay by card, please download and fill in this consent form, which will allow me to securely store your card information and charge for sessions.