DISCLOSURE, TELE-HEALTH DISCLOSURE AND CLIENT SELF REPORT. These documents need to be completed, signed and returned to me for your first appointment. Notice of Privacy Practices (NPP) and WA State DOH “What to Expect” documents are for your information and keeping. If you are using an EAP benefit that has their own Statement of Understanding (SOU), I will get that form to you, or read it during our first appointment in which you will verbally agree to the information.
*IF YOU ARE PRINTING FROM THE WEBSITE, PLEASE READ THE MAILING INSTRUCTIONS BELOW.
There are several options for completing intake paperwork: you can print and complete the forms, then mail them to me at PO BOX 1882, VASHON, WA 98070. Alternatively, I can send you the forms electronically via encrypted e mail or in paper form snail mail with a SASE for easy return. Please do not scan and e mail forms/ Protected Health Information (PHI) to me unless encrypted.
Michele Kimble, M.Ed., LMHC 