Client Forms

Client Forms

If you’re a new client, please complete the following forms and bring them to your first therapy session.

Client Information
My Policies
My Policies (Couples)
Insurance Information
Client Questionnaire

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Release of Information

 

Contact Today



619 N 35th St
Seattle, WA 98103

derek@ishrinkseattle.com
(206) 679-6619

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By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.