Welcome New ClientsPlease submit your intake form below. Tell us about who you're requesting this appointment for...I'm scheduling an appointment for:* Myself My Child My Spouse Other If "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. Patient's Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Patient's Age*Please enter a number from 1 to 99.Patient's Sex Assigned at Birth*MaleFemalePatient's Preferred Pronouns Preferred Method of Contact* Email Phone Text Select AllCommentsThis field is for validation purposes and should be left unchanged. Existing ClientsFor current patients. Enter your therapist's name in the search, then login using your username after you setup your account.Patient Portal
