Elizabeth Polasek, M.A., LMHC.

South 
Whidbey Island

Call:   360-632-3353


Client Information and HIPPA form
Release of information - Confidentiality Form

Click on Links below to open forms.

The first form is for the first session and the second form is only for release of information when needed.

Print form, fill out, sign and bring to first session.