Client Forms

These forms are for the convenience of my clients. They're in Word for PC, so if you have a Mac you'll need to use the pdf format or contact me for these forms.

Click on the link to the form you want. A new browser window will open - just close it to return to this page when you're done with the form. Fill in the information and email it to me as an attachment or print it and fax it to me at 425-822-3418.

Counseling Forms

• Office Policy and Procedure
  Office Policy and Procedure - pdf
  
• Notice of Privacy Practices For CD Revised 9-9-06
  Notice of Privacy Practices - pdf
  
• Client Information
  Client Information - pdf
• Current Problems or Symptoms - pdf

Coaching Forms

• Coaching Agreement
  Coaching Agreement - pdf
  
• Credentialing Form
  Credentialing Form - pdf
• Client Profile
  Client Profile - pdf
• Pillars of a Balanced Life Assessment
  Pillars of a Balanced Life Assessment - pdf
• 30 Day Goals
  30 Day Goals - pdf
• One Year Goals
  One Year Goals - pdf
• Five Year Goals
  Five Year Goals - pdf
• Coaching Call Focus
  Coaching Call Focus - pdf

Workshops and Groups

• Family and Addiction Workshop Registration
  Family and Addiction Workshop Registration - pdf
• Finding the Center Within 12 Week Group
  Finding the Center Within 12 Week Group - pdf

Fee Schedules for Coaching

• Phase 1 Recovery Coaching
  Phase 1 Recovery Coaching - pdf
• Phase 2 Recovery Coaching
  Phase 2 Recovery Coaching - pdf
• Custom Recovery Coaching
  Custom Recovery Coaching - pdf

Please contact me at 425-822-3425 today
for your free 15 minute consultation.

10512 NE 68th St., Suite 202
Kirkland, WA 98033

Phone: 425.822.3425  Fax: 425.822.3418

135 Wakea, Suite 208
Kahului, Maui, HI 96732

Phone: 808-280-3438