Forms

Please take the time to fill out the following forms, this will help us make better use of your time during your first session. Each person involved in counseling should fill out the forms individually.

Client Intake Form

Informed Consent

Self Assessment

Insurance Form (You only need to fill this out if you think your insurance will cover counseling)

To schedule a free consult
or for more information call
Dan Pippinger at:


(360) 779-7921


or e-mail me at


dan@restorationcounseling.us


1040 Hostmark St.; suite 100D
Poulsbo, WA 98110

My office is easy to find located in the Olympic Place Building in Poulsbo and convenient to Bainbridge Island, Kingston and Silverdale.

Directions

 

 



Dan Pippinger LMFT
Licensed Marriage and Family Therapist