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Download Forms

• Authorization Forms
• General Information
• Insurance Forms

Authorization Forms

• Authorization form: from UW Medicine
  Authorization for UW Medicine to disclose protected health information
  Adobe PDF: 27k
   
• Authorization form: patient information request
  Patient request for access to protected health information
  Adobe PDF: 24k
   
• Authorization form: to UW Medicine
  Authorization to disclose protected health information to UW Medicine
  Adobe PDF: 25k
   

General Information

• Client intake form
  The following intake form is to be filled out by all new clients. You are welcome to print the paper version of this form and bring it with you to your intake appointment.
  Microsoft Word document: 24k
   
• Waiver form
  Notice of third party non-coverage.
  Adobe PDF: 59kb
   

Insurance Forms

• Student Plan: Other insurance form
  Adobe PDF: 40k