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Legal Sex (for insurance)
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Insurance Information

Relation to Subscriber
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Relation to Subscriber
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Are you covered under Apple Health/Medicaid

If yes, plan MUST be Coordinated Care or Molina to be seen at LS. We are UNABLE to accept any Medicaid plan we are not contracted with.

Are you covered under Medicare?

LS can't see clients with Medicare

Reason for Seeking Services

Mental Health
Specific Services
Maternal and Infant Health

If you selected "Other," please explain. Any information provided helps therapists determine if their experience and credentials match what you are looking for.

Current Concerns

Is anyone in your household currently pregnant, or pregnant within the past 3 years?
Are you currently experiencing domestic violence?
Will gender or sexuality be a topic that is discussed?
Will sex, sexual concerns, or sexual kinks/fetishes be frequently discussed?
Are you currently having health concerns that are being treated by a physician?
Are you currently experiencing suicidal thoughts or self-harming behaviors?

Current Concerns

LS is required to abide by legal parenting plans, guardianship documentation, restraining orders, and related legal documents. We are required to receive consent from any adult with decision-making ability for non-emergency medical treatment for children under 13 years old (RCW 71.34.530), and for children under 18 who are not attending counseling voluntarily (RCW 71.34.650).

Are the client's biological parents married?
Is there a parenting plan in place?

If yes, a copy is required to stay on file. Please attach, email to info@integratedtherapynw.com, or fax to 253-564-4409.

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If bio parents are not together, who has decision-making ability for non-emergency medical treatment?

Preferences

Therapist Preference

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

Time
Day

Please note, afternoon and evening times are the most highly demanded and will likely result in a longer wait time.

Do you prefer Telehealth or in-person appointments?

In order to have a Telehealth appointment, the client must be physically located in the state of Washington due to provider licensure.

In order to receive services sooner, are you willing to schedule outside of your preferred time or method?

ITS DISCLAIMER: In-person appointments may increase your risk of contracting COVID-19. Therapy rooms are being sanitized in between every session. Selecting "In-Person" appointments does not limit you from using telehealth services in the future and may be set up at any time.

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Address

3627 Ensign RD NE
STE B, Olympia WA 98506

Contact Info

Tel: (360) 705-9835
Fax: (360) 956-1170
Admin@livingsound.net

Schedule

Mon - Fri: 9am - 6pm
Saturday: Closed
Sunday: Closed

Copyright © 2025 Living Sound Therapeutic Services. All Rights Reserved

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