Minding Your Spirit Together

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Forms:

For Your Information:

Location:

Phone:

Fax:

Gateway Centre

1313 E. Maple Street

Bellingham, WA 98225

360-647-8295

360-647-8296

I currently see patients on the following schedule:

Wednesday

9am - 12pm and 1pm - 5pm

To Request a Therapy Appointment:

Before calling for an appointment, please review your insurance coverage to ensure that I will qualify for reimbursement from your particular insurance carrier. If you need a referral from a family doctor or some other party, please arrange that before calling for the appointment.

Please call my office phone number and ask a receptionist to schedule a first appointment. First appointments are scheduled for 90 minutes. Therapy appointments are 45-60 minutes.

I offer therapy to adults, couples, and parents with children. I also see late adolescents, 14 years old and older.

Here are the intake forms for therapy with me. Please print these, complete them and bring them with you to your first appointment.

A registration form
An agreement to accept psychological services
A release of information form in case you would like to provide someone (for example, your physician) with information about your treatment here.
A medical history (women's / men's) form to give me some information about your health.
An acknowledgement that you have received the HIPAA privacy form.

Here is the information my office needs to provide you. Please print these for your records:

A brief biographical brochure about Dr. Nyblade
A notice of our privacy practices
Your copy of the agreement to accept psychological services

If you have questions about any of these materials, or questions about anything to do with your therapy or evaluation by Dr. Nyblade, make a note of them and bring them with you. If you’d like Dr. Nyblade to be aware of written materials, for example a previous evaluation by a psychologist or a school, or a physician report on your health, please bring a copy to your appointment.