New Client & Patient Forms

New Client/Patient Forms:

Dear Clients/Patients,

Welcome to Dialogical Therapy, Fletcher B. Taylor’s  & Alita Kathryn Taylor’s group psychiatry/psychotherapy practice. We look forward to serving you.

Before commencing treatment with us, it is essential that we obtain your written consent for treatment. You have options for this. For your convenience, either:

      1. Email admin@dialogicaltherapy.com (secure/HIPPA-compliant, end-to-end encrypted) and request electronic intake form(s.) We will then email you each form which you can e-sign. We will receive each one after you click “Submit” at the bottom of each form. *If you are wanting us to submit claims to your health insurance company, please don’t forget to email admin@dialogicaltherapy.com the front and back of your health insurance card(s.)*

      2. Download (see links below,) print, complete, sign, and send completed forms to us via FAX (253-212-3225) or via email admin@dialogicaltherapy.com (secure, HIPPA-compliant, end-to-end encrypted.) *If you are wanting us to submit claims to your health insurance company, please don’t forget to FAX (253-212-3225 or email admin@dialogicaltherapy.com  the front and back of your health insurance card(s.)* 

          1. Agreement for Treatment Form

          2. HIPPA Authorization Form (PDF)

      3. Arrive 15+ minutes prior to your scheduled appointment time. Forms will be provided to you to complete. *If you are wanting us to submit claims to your insurance company, please don’t forget to bring your health insurance card(s.)*  (*Note: This option does not apply for first-time Telemedicine appointments.)

If you have any questions please call us at 253-212-3101. We want to make your experience seeing us as smooth and as comfortable for you as possible.

Sincerely,

Dr. Fletcher B. Taylor and Alita Taylor, MA, LMFT