Estimated time to complete : 5-10 minutes
Congratulations in taking steps towards a healthier existence, and towards getting the support you need. Moving towards improvement begins with us getting to know your needs and your wants. The better we understand you, the better we can help you.
Our intake is a two-part process. Once you have completed this intake form and our office staff have set up your health chart, we will contact you to set up the in-person portion of the intake. This initial intake evaluation session* (generally 45 minutes) will be conducted by a staff psychiatric provider who is qualified to diagnose mental health as well as medical issues that may be creating or affecting any of your presenting issues (unfortunately licensed counselors are not qualified to identify medical issues and there are many behavioral health issues that are actually caused or exacerbated by underlying medical issues). The intake session is not intended to explore relational or emotional issues, but is an evaluation and therefore rather more fact-finding in nature. Once both portions of the intake have been completed you will be able to set up your regular appointments with your chosen provider.
WE ARE SORRY BUT WE CANNOT ACCEPT SAME DAY NEW APPOINTMENTS. This is because we have paperwork you must fill out prior to your first session. You also will need enough time to call your Insurance company and obtain your insurance benefits prior to your first appointment. You must receive a confirmation for your requested appointment time. Please do NOT show at our offices without receiving this confirmation from us via email.
Please note that if you plan to use health insurance you should come to your first visit with your current insurance benefit information checked and confirmed as you may have a deductible to meet before treatment is covered by your plan. Some services we provide may not be covered by insurance - please check with us if you are not sure.
Any information submitted using the form below will be encrypted before it is transmitted to our offices, where it is securely stored according to HIPAA regulations. Your confidential information is sent to us directly and is not stored unencrypted at any point in any thrid-party services or hosts.
* You may decline the psychiatric evaluation portion of the intake if you have had a psych eval conducted by a qualified psychiatric provider elsewhere in the last 12 months and can provide a copy of the evaluation, or if you have any objection to receiving an evaluation. Please ask us for a declination waiver form.
Okay, great, you are filling out this form for someone else. Please now answer the rest of the form as the client (their birthdate, insurance, etc).
Kaiser Core HMO has a specific requirement that, prior to your session, you MUST call them to have your session pre-authorized or they will deny your claim and you will be responsible for the full session fee. The call should take only a few minutes to complete. The number to call is;
If you are feeling suicidal right now, have a plan or intent, please call
or go to your
If you have been feeling generally suicidal, but have no specific plan, please call the national crisis suicide helpline
or you can also chat online
Suicidal feelings are not uncommon and can be difficult to handle in the moment, but as bad as you might feel, it is important to remember that like any feelings, those moments will pass and feelings will go. Suicidal feelings are temporary ways that your mind lets you know you need help. We will help you towards understanding these feelings, reducing the intensity, and working towards healing growth. Making an appointment with us is a great first step in dealing with these feelings, but remember that we can only meet with you at your scheduled appointments and we are not your first port of call when these feelings become too much for you. It is essential that you call 911 or the crisis line as appropriate when you start to feel suicidal, and important that you keep your scheduled appointments with us and tell us about your feelings during your session.
This is your care, your time, and we want to hear as much of your needs, or your story, as you want to express. And if you'd prefer to wait to tell it to your provider then that is okay too.
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Misc client tips
Bellingham OfficeTel: (360) 329-2055Fax: (360) 547-7780
21 Bellwether Way
Bellingham, WA 98225
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Tel: (360) 602-1316Fax: (360) 547-7780
Rape, Abuse, Incest1-800-656-4673