Helen Widlansky, Phd – Licensed Clinical Psychologist

2811 East Madison Street, Seattle, WA 98112

847.477.0355 or 206.946.2365

FEES AND BILLING

I am paneled with both Blue Cross Premera and First Choice Insurance Plans.  For all other plans, I am an out of network provider.  To facilitate your receipt of out of network reimbursement, I will provide you with the statements the at your insurance requires. If you plan to use your insurance for therapy, I strongly advise you to call your insurance company prior to our first meeting to be clear of your benefits.

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CANCELLATION / LATE ATTENDANCE POLICIES

You may cancel an appointment with at least 48 hours notice.  If you have not given 48 hours notice you will be responsible for paying for your reserved time slot.  Insurance companies will not cover missed appointments.

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DOCUMENTS AND FORMS FOR NEW CLIENTS

Please print and complete the following forms prior to our first meeting.

1. Intake Form for New Client

This form takes 10 minutes or less to complete and allows me to more quickly understand what brings you to therapy.

  1. Disclosure and Consent to Treatment

This form provides information about our therapeutic agreement.  You will need to sign this form before we begin our work together.

  1. Privacy Notice  

This document provides more detailed information on your rights to confidentiality.  This form is yours to keep and no signature is required