Without Hope There is No Help
Auburn Remote Hippa Compliant Remote Therapy - Teletherapy
Phone: (253) 333-2328
Fax:  (253) 333-5068
Address: 230 Auburn Way S. Suite 1B
Auburn, WA. 98002
Call by 10a.m. for same or next day appointment. Please call the main # and hit extension 1 for scheduling!

Mental Health Intake Form

Please answer the Mental Health Intake Form below. Alternatively you can download the form here.
If you haven't already done so, please also fill out the insurance form here.

These forms must be filled out prior to your initial consultation.

    • 01 - Basics
    • 02 - Suicide Risk Assessment
    • 03 - Past Medical History pt.1
    • 04 - Past Medical History pt.2
    • 05 - Past Psychiatric History pt.1
    • 06 - Past Psychiatric History pt.2
    • 07 - Past Psychiatric History pt.3
    • 08 - Exercise Level & Substance Use
    • 09 - Tobacco History
    • 10 - Family Background & Childhood History
    • 11 - Trauma, Educational, & Occupational History
    • 12 - Family & Personal History


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(253) 333-2328
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Auburn, WA