1715 C Street Bellingham, WA 98225
Phone: 360-715-2488
Fax: 360-671-1842
Email: associatesinmentalhealth@yahoo.com

 

Client Forms

We appreciate the time you are taking to fill out our paperwork. You can either print out each form and fill it out by hand, or you can type your answers into the spaces provided on the web page and then print the page. Please note that the information you type into the forms on the web pages will be cleared when you close or navigate away from the page. You must print them out. Due to security and confidentiality issues, we have not made it possible for you to return these forms to us electronically. Please bring all of your completed forms to our office when you come for your appointment.

There are several forms to complete. If you are an adult seeking treatment for yourself, you will fill out the Adult Intake Form, the Adult Medical History Form, the Adult Treatment Goals Form, and sign the Health Insurance Portability and Accountability Act (HIPAA). All of the forms for adult clients can be found on the Adult Forms page.

If you are a minor or an adult seeking treatment for your minor child, you will fill out the Child Intake Form, the Child Medical History Form, the Child Developmental History Form, the Child Psychiatric Form, and sign the Health Insurance Portability and Accountability Act (HIPAA). All of the forms for minor clients can be found on the Child Forms page.