Relationships & Marriage Counseling
1601 116th Ave NE, Ste. 102
Bellevue, WA 98004
425-417-4700
Print these forms and bring them to your first session.
How to Get Started
Forms
The first two forms below are required by law to be provided to you. The New Client Questionnaire is necessary for me to provide service. Please download, print and complete these first three forms and bring them to your first session. If you have any questions, please feel free to call 425-417-4700 or bring your questions to our first session.
Disclosure of policies agreement
HIPAA notice of privacy & receipt
*Optional forms
Parent Coaching Introductory Form
Client release of information agreement
Fees
Your insurance company may provide coverage for our services. Please check directly with them. If you request, we will provide you with an invoice upon receipt of payment. In some cases we are happy to handle submitting claims directly to your insurance company.
Rates:
Marlon Familton - individual,
family & couples: $90 to $135 per session based on
duration.
*Couples and family sessions
often run 90 minutes, or $135.
Leah Koenig - parent coaching & play therapy: $80 per hour.
We accept cash, checks, and VISA/MC/Discover/American Express and Pay Pal.
Please call 425-417-4700 to schedule an appointment or use the online scheduler.
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