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    • Christian Bringolf MA LMHC >
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Burien Counseling

forms

Christian Bringolf MA LMHC Forms

Please print off, review, sign and bring all the documents, with you to your first session.  
​If you have questions about these documents, please contact me and I'd be happy to answer them.
disclosure_statement_updated_cb.pdf
File Size: 188 kb
File Type: pdf
Download File

new_pt_intake_060419.pdf
File Size: 58 kb
File Type: pdf
Download File

new_credit_card_auth.pdf
File Size: 61 kb
File Type: pdf
Download File

fee_agreement.pdf
File Size: 126 kb
File Type: pdf
Download File

hipaa_npp.pdf
File Size: 90 kb
File Type: pdf
Download File

​Drayton Lemert MA LMHC Forms

bc_authorization_form__1_.pdf
File Size: 89 kb
File Type: pdf
Download File

hipaa_d__1_.pdf
File Size: 92 kb
File Type: pdf
Download File

bc_drayton_lemert_ma_lmhc_disclosure_statement__2_.pdf
File Size: 257 kb
File Type: pdf
Download File

medical_purpose__1_.pdf
File Size: 80 kb
File Type: pdf
Download File

intake_form_ii.pdf
File Size: 29 kb
File Type: pdf
Download File

new_credit_card_auth__1_.pdf
File Size: 13 kb
File Type: pdf
Download File

Geramy Hudson MA LMHC Forms
geramy_disclosure_statement.pdf
File Size: 81 kb
File Type: pdf
Download File

updated_fee_agreement.docx.pdf
File Size: 40 kb
File Type: pdf
Download File

hipaa_npp[7727].pdf
File Size: 92 kb
File Type: pdf
Download File

geramy_credit_card_authorization.pdf
File Size: 12 kb
File Type: pdf
Download File

new_patient_intake_form[7724].pdf
File Size: 59 kb
File Type: pdf
Download File

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Burien, WA 98166


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  • Home
  • Licensed Counselors
    • Christian Bringolf MA LMHC >
      • Experience
      • Credentials & Education
    • Drayton Lemert MA LMHC >
      • Experience
      • Credentials & Education
    • Geramy Hudson MA LMHC >
      • Credentials and Education
  • Interns
  • Fees & Information
    • Services
    • Christian Bringolf Fees & Information
    • Drayton Lemert Fees & Information
    • Geramy Hudon Fees & Information
    • Marilyn Baker Fees and Info
    • Kayla Metzger Fees and Info
  • Forms
  • Location
  • Resources
  • Contact Us
  • Blog
  • Consultation & Supervision Services