Forms
Here the forms that you will need for your counseling.  You can either fill out the form online and print it.  What you fill in cannot be saved or sent, but can be printed out. 

Insurance:  If you want me to check your insurance coverage, fax the insurance form to me at FAX no: 425-334-2427.  I can then follow up by calling either your insurance company or the provider you want me to speak with.  There is also a fill-in-able form that is secure and encrypted for confidentiality through Starfield.

COUNSELING FORMS

Counseling Form (PDF) (This is fill-in-able)  The first two pages are client agreement, but then fill in the rest of the pages on your computer. 

This form contains:

• Counseling Agreement

• Client Information

• HIPPA form

• Directions to the office

You can fill them in and print them out either on your computer (PDF version) or print it out and fill in by hand.  Printable Form (non fill-in-able)

If you have insurance Blue Cross, Blue Shield or Uniform Medical you will  want to download this form as well.

 Insurance Form

 If you want me to check your insurance coverage, fax the insurance form to me at FAX no: 425-334-2427.  I can then follow up by calling either your insurance company or the provider you want me to speak with.

SEPARATE INDIVIDUAL FORMS

If you need individual forms for whatever reason here they are.  If you needed an extra form for marital counseling you will want to an extra "Counseling Agreement" and "Client Information" form.

"Client Agreement"  (in MS Word)

"Client Agreement" (in PDF)

This form describes my credentials, confidentiality and your rights as a client.  This form begins our counseling relationship and is signed at our first counseling session.

"Client Information" (in MS Word) 

"Client Information" (in PDF)  (This is fill-in-able)

This form helps you bring summarized information to your session.  It give me an idea of who you are and saves counseling time and cost when you fill it out.

"Insurance Information" (in MS Word)

"Insurance Information" (in PDF) (This is fill-in-able)

This form allows me to contact your insurance company regarding coverage.  You can sign it and fax it to me if you want.

"Disclosure Form to talk with other Professionals" (in MS Word) 

"Disclosure Form to talk with other Professionals" (in PDF)

This form, after signing it, allows me to talk with another professionals about your care.

"Notice of Privacy Policy" (in MS Word) 

"Notice of Privacy Policy" (in PDF)

This describes our privacy policies according to HIPPA

Directions to Erik Bohlin's Offices (In PDF) (in MSWord)