Helpful Forms

Individual Counseling
If you're a new client, it would be very helpful for you to complete the New Client Information form and bring to your first therapy session.
If you would like me to coordinate care with another provider please complete the consent form to authorize release of psychotherapy information

  • New Client Registration

  • Adult Health Information

  • Minor Health Information

  • Guidelines for Child Therapy Work for Two-Home Families

  • Consent for Exchange of Information

Child Specialist Coaching Services

Pre-session information: 

  • Child Specialist Coaching: Pre-Session Information

Collaborative/Cooperative or Coparent Coaching Contracts:  

  • Collaborative Child Specialist Contract  (for those in a formal Collaborative Divorce process)

  • Cooperative Child Specialist Contract  (if you are not in a formal Collaborative Divorce process or aren't sure) 

  • Coparent Coaching Contract (for parents seeking coaching post divorce)

Children's Consent to Release Information (If you adult or minor children are meeting with me for part of your Child Specialist process, I will ask them to sign these forms during their session): 

  • Adult Consent for Exchange of Information

  • Minor Consent for Exchange of Information

For scheduling and general information

The Evergreen Clinic
New Client Line: (425) 825-9644
Main Office: (425) 821-1810

12025 115th Ave NE Bld D Suite 200 Kirkland WA 98034

Questions/Contact Me

(206) 295-8673 

Office Hours

Monday & Tuesday 10-4

​​Wednesday & Thursday 10-6

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