Below are the primary pre-meeting forms. One, the “PDS” (Professional Disclosure Statement) is for you to learn about me, my approach, my licensing and practice status as well as your rights. If you read this in advance it may prompt questions for us to cover in our first session. The intake form and others, you may print off and fill out in advance of our first meeting if you wish. Otherwise, I will have copies available for you to fill out at that first meeting. Remote-only sessions must have these forms filled out, saved and returned to me by our first meeting.
- New Client Intake Form1
- Additional Intake Form2
- Katharyn Waterfield, LPC_Professional Disclosure
- Consent to Treat
- Electronic (non-secure) communication consent
The fees I charge are based on a sliding scale of personal income. I also hold open appointment slots for those in more financial need. Please let me know if you need to investigate this option. This means – please ask!
The time you and I set aside for you is your time alone. This time has been reserved for you. Please provide at least 24 hours notice if you are unable to keep the initial appointment. Honoring the value of both of our allocations of time, I ask for a week’s notice for future schedule changes. Exceptions will be discussed in our initial session.
I am currently in network for limited insurance companies (Moda, PacificSource) and do not foresee adding any other engagements. It is possible for me to provide you with an insurance-acceptable invoice (“superbill”) which you can submit to your insurance company for reimbursement. (Please note that personal information is required by the Insurance Co to reimburse. We should discuss in advance to make sure this is your choice.) It is your responsibility to check with your carrier to find out what reimbursement you may or may not be eligible for. My full fee will be charged for anyone needing ongoing insurance documentation (such as the Superbill.)