Welcome New ClientsPlease submit to begin your intake process. Thank you.Tell us about who you're requesting this appointment for...I'm scheduling an appointment for:* Myself My Child My Spouse OtherIf "Other", how is this person related to you?*Patient's Name* First Last Your Name* First Last What would you like us to call you?Your Email Address* Email Address Confirm Email Address Phone Number*How Can We Help?*What kind of services are you looking for?Individual Adult TherapyChild TherapyFamily TherapyRelationship TherapyMedication ManagementCombination of ServicesI'm not sure, I'll need guidanceCommunications Consent I agree to receive appointment reminders and other important messages from PSP.I agree to receive recurring automated marketing text messages at the phone number provided by Puget Sound Psychotherapy. Msg & data rates may apply. Msg frequency varies. Reply STOP to opt-out at any time. View our Privacy Policy and Terms & Conditions.CAPTCHAPatient's Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Patient's Age*Please enter a number from 1 to 99.Patient's Sex As Matching Insurance Policy*MaleFemalePatient's Gender IdentityCisgender MaleCisgender FemaleTransgender MaleTransgender FemaleNon-binaryGender-queerQuestioning/Not sureOtherPatient's Preferred PronounsPreferred Method of Contact* Email Phone TextSelect AllCommentsThis field is for validation purposes and should be left unchanged. Existing ClientsClick the link below to access the patient portal.Patient Portal
