Information for New Patients

New Patient Forms (Secure & Online)

To streamline your first appointment, please complete the following forms online. This is a secure, HIPAA-compliant process, and your information will be sent directly to our private records system.

Please complete all forms at least 48 hours before your first appointment.

1. Start Secure Intake Form 2. Sign NPP Acknowledgement 3. Sign Telehealth Consent

Insurance Accepted

I am in-network with the following insurance providers:

  • Aetna
  • Cigna and Evernorth
  • First Choice Health | FCH
  • First Health
  • Kaiser (Out-of-Network)
  • Medicare
  • Moda Health
  • PacificSource
  • Premera Blue Cross
  • Regence
  • UnitedHealthcare UHC | UBH

Private Pay Fees

For patients who are not using insurance, my fees are:

  • Initial 60-minute Evaluation: $200
  • 30-minute Follow-up: $150

I can provide a superbill for you to submit to your insurance for potential out-of-network reimbursement.