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Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

  • Client Psychotherapy Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

  • Authorization to Disclose Information Form

Client Psychotherapy Intake Form  
Limits of Confidentiality/Therapy Cancellation Policy  
Authorization to Disclose Information Form  

Note: To download Adobe Acrobat Reader for free, click here.





















Helpful Forms

Click here to view and print forms for your appointment.

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Dena Nichols,
MS, LMHC

 
Experience in issues related to:  ADD/ADHD, Anxiety, Depression, Grief, Infertility, Major Life Transitions, Relationship Struggles, Parenting,
Pregnancy Loss.
   


Serving the areas of: 
 Kirkland | Sammamish | Redmond | 
Bothell | Bellevue | Woodinville | Seattle
Washington


Kirkland, WA Therapist

Dena Nichols
10604 NE 38th Place, Suite 132
Kirkland, WA, WA 98033
(425) 941-1275

dena@nicholstherapy.com