Forms
Here are some forms that you can download and sign and bring with you to counseling.  If you want me to check your insurance coverage, fax the insurance form to me at 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.

INTRODUCTORY PACKET OF INFORMATION

Introductory Packet to see Erik Bohlin, M.A.

Introductory Packet (in PDF)

This packet has the "Counseling Agreement," "Client Information" and directions to our office. It also has the HIPPA forms which disclose our privacy practices.   Feel feel to fill out and bring them with you or fax them to us.  The phone numbers are on the packet.

If you have insurance, you will want the "Insurance Form" as well.

SEPARATION INDIVIDUAL FORMS

"Client Agreement"  (in MS Word)

"Client Agreement" (in HTML)  

"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 fillable form)  NEW

"Client Information" (in PDF)

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

"Insurance Information" (in MS Word)

"Insurance Information" (in HTML)

"Insurance Information" (in PDF)

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"

"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 (In PDF) to Erik Bohlin's Offices in Lake Stevens and Lynnwood