Forms

Before your first appointment, please read the disclosure statements below, sign the signature page and complete the Intake form and bring them with you on your first visit.  Please check with your insurance as to whether you have met your deductible and for the amount of your co-payments. Thank you!
PLEASE MAIL THESE DOCUMENTS TO PO BOX 392, Poulsbo, WA 98370 or send through HIPPA compliant email swhitema@hushmail.com

Intake form

Client Rights

Therapist Disclosure

Credit Card Form

Insurance & Billing

I am in-network with Premera, First Choice Health, and Cigna. I will bill insurance companies directly. Any co-payments are due at the time of each visit. Please check with your insurance as to whether you have met your deductible and for the amount of your co-payments.

Office Locations
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Poulsbo Office:  
Currently seeing clients virtually only.

Mailing address is:
PO Box 392, Poulsbo, WA 98370

Edmonds Office: 
Currently seeing clients virtually.

​Mailing address is:
PO Box 392, Poulsbo, WA 98370