Nicole T. Shiraev, MSW, LICSW, PLLC
Psychotherapist in Private Practice
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New and Existing Client Forms

In February 2024 I began migrating from my previous electronic health records and electronic practice management platform, Practice Fusion to Simple Practice.  New and existing clients will be asked to connect with their client portals in Simple Practice and will be able to receive, complete, and sign all forms through their client portals.  Forms will be shared and available to clients in their client portals as I need them to maintain client records and/or upon client request as clients need to update me on any changes to their information.

Occasionally however I realize we may come across a situation where we may need another way to access a copy of the consent to exchange information and so you can continue to access the consent to exchange information form in PDF format below that you can print and complete and share with another member of your care team as you see fit and later upload to your client portal within Simple Practice to share it with me.
Consent to Release Healthcare Information
File Size: 105 kb
File Type: pdf
Download File

Nicole T. Shiraev, LICSW, PLLC (She, Her)
150 Nickerson Street, Suite 105
Seattle, WA 98109
Phone: (206) 496-2426 
 Fax: (206) 327-9169
[email protected]
Photo from Harry Pammer (temporarily off)