Ellen Begley, Ph.D., PLLC Licensed Psychologist

  • Home
  • Overview
  • Intake Forms
  • Billing/Insurance
  • Office Locations
  • Intake Forms

New Patient Forms

Below you will find five PDF documents to print, read, complete and bring to our first appointment.  They include 1) New Patient Information form, 2) Policies and Practices 3) Agreement for Psychological Services, 4) Authorization to Exchange Information with prior providers, 5)  Consent to Telehealth. 

If you are not able to read, print, and complete these forms call Dr. Begley at 206-650-4504 and let her know before you meet with her. 
new_patient_registration_2024.pdf
File Size: 109 kb
File Type: pdf
Download File

dr._begley_policy_and_practices_pdf.pdf
File Size: 89 kb
File Type: pdf
Download File

agreement_for_psych_services_2014_pdf.pdf
File Size: 112 kb
File Type: pdf
Download File

roi-authorization_to_release_information
File Size: 30 kb
File Type: roi-authorization to release information
Download File

telehealth_consentpdf-2022.pdf
File Size: 52 kb
File Type: pdf
Download File


Web Hosting by iPage