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 ClientsFor current patients. Enter your therapist's name in the search, then login using your username after you setup your account.Patient Portal
