Client Forms
Please read and complete these forms before your first session. Each form can be filled in on a computer, or printed and completed by hand.
How to return your forms
Please do not send completed forms by regular email, since email is not private. Return them through the secure upload in Doxy.me when I request them, or bring them to your first session.
Forms for every new client
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Disclosure Statement and Consent (4 pages). Washington State asks every licensed counselor to give you this before counseling begins.
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Confidential Client Intake (5 pages)
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Notice of Privacy Practices (3 pages). Also on its own page: Notice of Privacy Practices.
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Financial Policy and Payment Agreement (2 pages)
Forms for some clients
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Authorization to Release Information (1 page). Use one for each person or organization you want me to share information with.
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Good Faith Estimate (1 page). For clients without insurance, or not using it. I prepare this estimate for you.
Fees and insurance
See Fees and Insurance.
Need the forms another way?
To receive any form in another format, email Liziah@Liziah.com or leave a voicemail at 206-240-8054.
In a crisis
Call or text 988, call 911, or go to your nearest emergency room. Email and voicemail are not monitored for emergencies.