Client Forms

Have you completed a request for services with our Access Department? If so, please complete your pre-assessment paperwork below. If not, please contact our Access Department at 425-349-8200 / 844-822-7609 or complete our Online Referral Form to start your referral process.

Instructions on how to sign & submit the below Pre-Assessment forms electronically

Forms should be completed using Adobe Acrobat Reader DC on your computer or mobile device. Adobe Acrobat Reader DC is free to download here.

Pre-Assessment Forms

After speaking with the Access Team, if you will be participating in a Telehealth appointment, fill out the Pre-Assessment Forms. You can access each form below by clicking on the name of the form in orange:

  • Consent for Treatment
    • The following individuals may sign a Consent for Treatment:
      • Adults age 18 and older, unless declared incapacitated by a court of law (i.e. have a legally appointed guardian).
      • Minors age 13-17
      • Parents of a minor child (age 17 or younger) – adolescents should sign their own pre-assessment paperwork forms
      • Legal guardians
      • Kinship Caregivers – family members of a child under the age of 13 who are providing care for the child in the absence of a parent or legal guardian. Parent/guardian is not available.
      • If the client is unable to sign for themselves (i.e. under 13, or an adult with a legal guardian) someone who can sign consent must attend the assessment with the client, or must sign the Consent for Treatment in advance).
    • How to complete the Consent for Treatment:
      • Check all applicable boxes on pages 1
        • For packet material, only need to check the Financial Agreement box
      • Sign and date on page 4
      • Enter your Name & DOB on each page
      • Only Kinship Caregivers must complete page 5
  • Financial Agreement
    • How to complete the Financial Agreement:
      • Check all applicable insurance boxes on page 1
        • Must include your ProviderOne ID # in the Medicaid section (example: 123456789WA)
      • Sign and date on page 2
      • Enter your Name & DOB on each page
  • ROI (Release of Information)see note below
    • If you are not intending to release, exchange, or disclose your medical records to another individual, then do not complete the ROI at this time.
    • Who can sign an ROI? If the client is 13 or above, they must sign the ROI; if the client is 12 or younger, a parent/guardian must sign the ROI.
    • In order to best assist your treatment, it is strongly encouraged to complete the following ROIs:
      • PCP
      • If a minor client is age 13 or above, we strongly encourage an ROI for the parent or guardian.
      • Other typical ROIs that we request from new clients include requests from School Counselors, Social Workers, other Medical Providers including recent hospitalizations, etc.
    • Instructions for completing an ROI:

If this is a standalone request for information unrelated to submitting pre-assessment forms, please go to our Medical Records page.

  • Client Forms Submission

Client Forms Submission

Please submit your completed forms here (Consent for Treatment, Consent for Telehealth, Financial Agreement, ROI). Please submit all the signed and dated forms together.

  • Date Format: MM slash DD slash YYYY
  • Drop files here or
    *We cannot accept picture uploads (png or jpeg files)
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