New Client Questionnaire

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This form is to get established on the wait list for mental and/or behavioral health services at Integrated Therapy Services NW. Once the form is submitted, our office will contact you within one business day. If this is an emergency, please call 911 or contact the Pierce County Crisis Line at 1-800-576-7764, the Kitsap County Crisis Line at 1-360-479-3033, or the National Suicide Hotline at 1-800-784-2433. If you have any questions, please call or email our office at 253-460-7248 or

Contact Information

Insurance Information

Reason for Seeking Services

Current Concerns

Kids Under 18 Years Old

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    Availability - What days or times generally work best for scheduling appointments? Our office hours are Monday - Friday, 8 AM - 7 PM.

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