Forms

If you are new to our services, please fill out these intake forms and return them to Trauma Informed Therapies before our first session. These forms can also be filled out virtually by logging into the Theranest Client Portal. The Theranest Client Portal link is sent to the email address you provided when you scheduled with us.

TIT recommends you contact your insurance company prior to your first visit if you are considering starting treatment with us. It is important you understand the services your insurance will cover. Making this preliminary call by following the steps of this form provides peace of mind for many clients so they can turn their attention to treatment recommendations during their intake assessment appointment.

The following document allows Trauma Informed Therapies (TIT) to provide therapeutic treatment services only upon your consent:

Required by the State of Washington, the following documents provide information about the providers that you may be working with at TIT. These documents are yours to keep and contains important information about Trauma Informed Therapies policies and operations:

• • 1 COUNSELOR DISCLOSURE STATEMENT
  • 2 ADDENDUM TO THE WA COUNSELOR DISCLOSURE STATEMENT

  The following documents describe how clinical information about you may be used and disclosed and how you can get access to this information. These documents are yours to keep and contain important information about Trauma Informed Therapies policies and operations:

  • • Client Rights and Responsibilities
    • Notice of Privacy Practices

    TIT’s policy regarding payment for services, benefits, and file claims on your behalf:

    • • Financial Responsibility Agreement

      TIT’s policy regarding appointment cancellation and attendance:

      The following helps us get a better picture of your situation, concerns, and needs:

      Consent documents for TIT to share information about you and your care with your other healthcare providers and with family members and support people:

      • Electronic Authorization Form
      • Telehealth Consent Form
      • Release of Information

      222 W Mission Ave Suite 122
      Spokane, WA 99201