Counseling NW

Matthew R. Evich, MA, LMHC

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Forms & Insurance

Please download and complete the following documents for your first session:

• Disclosure Statement

• Adult Intake

• Release of Information

• Health Care Coordination

• Notice of Privacy

• Tele-Therapy Notice Service Agreement

• Audio-Only Telemedicine

• Good Faith Estimate

Instructions for using Tele-Therapy on your device

Accepted Insurance Plans:

Aetna
Blue Cross/Blue Shield
Cigna 
ComPsych
First Choice Health
Kaiser-Permanente
Life Wise
MHN
Magellan Behavioral Health
Molina
Optum (age 19+ clients only)
Premera
Providence
Regence
Several EAP programs
TRICARE
United Healthcare (age 19+ clients only)
Out of Network 

Billing Questions?
Please tell us if you are on Medicaid

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