SCW Therapy Intake Form (Individual) Logo
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  • Therapy Intake Form

  • We are looking forward to helping you!

    Complete this form to start therapy at Sentio. Please note the following information:

    • All therapy services at SCW are provided online.
    • Client fees are based on a sliding scale from $30-$95 per session.
    • Clients must be located in the state of Washington at the time of sessions.
    • SCW provides the highest quality services by using industry-leading quality assurance best practices including training in empirically-supported treatments, deliberate practice, routine outcome monitoring, session recording, and weekly supervision while counselors accrue hours toward licensure.
  • Client Information

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  • Clinical Information

  • Fee Setting and Availability

    The following table is used to calculate your fee per session based on your answers to the questions below.
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  • Informed Consent for Psychotherapy Services

  • This section explains several important aspects of treatment at SCW, including information to help you decide if you want to participate in psychotherapy. Additional information can be found in the following linked documents.

    • Notice of Privacy Practices
    • Informed Consent for Telehealth
    • SCW Good Faith Estimate

    1. Psychotherapy helps you clarify your thoughts and feelings so that you can set goals, resolve conflicts, and improve your relationships with other people. It involves talking about and working through concerns and problems. Therapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness.

    2. SCW clients begin by attending weekly sessions. If you and your therapist agree that it is beneficial to meet every other week as treatment progresses, you are welcome to do so. However, we do not provide regular services less frequently than once every two weeks. Additionally, SCW does not provide sessions more frequently than once every week except in the event of short-term crisis situations.

    3. With rare exceptions, all providers of service (therapists) at SCW are graduate students who are working toward graduate degrees in marriage and family therapy or Associate Marriage and Family Therapists who have graduated and are now accruing hours towards licensure. They provide services under the supervision of Washington licensed mental health professionals.

    4. All communications between you and your therapist will be held in strict confidence unless you provide written permission to release information about your treatment. There are exceptions to confidentiality. For example, therapists are required to report instances of suspected child abuse, or vunerable adult abuse. Therapists may also be required or permitted to break confidentiality when they have determined that a client presents a serious danger to themselves or another person (e.g. physical violence). Your rights to and the limits of confidentiality are fully discussed in the Notice of Privacy Practices.

    5. Communications between therapists and clients who are minors (under the age of 18) are confidential. However, parents and other guardians who provide authorization for their child’s treatment are often involved in their treatment. Consequently, your therapist may discuss the treatment progress of a minor client with the parent or caretaker.

    6. Appointments are usually scheduled for 50 minutes. If you are unable to keep your appointment, please give 24 hours advance notice to cancel or reschedule. If you do not give 24 hours advance notice to cancel an appointment, you will be charged the full session fee unless you and your therapist both agree that you were unable to attend due to illness or emergency.

    7. SCW fees are based on a sliding scale from $30-$95 per session. You will be expected to pay for each session at the time it is held unless you and your therapist agree otherwise. We do not bill insurance companies, and many insurance companies will not reimburse services provided at SCW since our therapists are in training. However, your therapist can provide a receipt to submit to your insurance provider if they are able to reimburse some of the cost.

    8. SCW counselors do not provide emotional support animal (ESA) letters, with rare exceptions.

    9. SCW collects information and data from you as part of routine practice, including your mental and physical health and wellbeing, recordings of sessions, and your opinion of services received here. This information and data is used to enhance treatment, for training purposes, for program management, and for research, including artificial intelligence and large language models. The information that the SCC collects from you may also be used for development of new services and products that may have commercial use or applications, including but not limited to artificial intelligence and large language models.

    10. The Washington State Department of Health receives and responds to complaints regarding services provided within the scope of practice of associate marriage and family therapists. You may contact them online at https://doh.wa.gov, or by calling (800) 525-0127. The clinic director of Sentio Counseling Washington receives and responds to complaints regarding the practice of psychotherapy by any unlicensed or unregistered counselor providing services at Sentio Counseling Washington.

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