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

You will find the forms I ask that clients complete before engaging in treatment.  I encourage you to take the opportunity to read and review at your leisure and contact me with any questions you might have.  If you prefer to complete new client forms on the day of your intake & assessment appointment, plan to arrive 15-20 minutes early.
New Client Registration Form
File Size: 52 kb
File Type: pdf
Download File

Consent for Services & State Required Disclosure Statement
File Size: 93 kb
File Type: pdf
Download File

Telehealth Services Consent Form
File Size: 66 kb
File Type: pdf
Download File

For New & Existing Clients
If you would like me to be able to exchange information with anyone (e.g., a primary care physician or other health care provider, a family member involved in your care).  This form is essential if you would like other care providers or family members involved in your care.
Consent to Release Healthcare Information
File Size: 105 kb
File Type: pdf
Download File

Nicole T. Shiraev, LICSW, PLLC
150 Nickerson Street, Suite 105
Seattle, WA 98109
Phone: (206) 496-2426 
 Fax: (206) 327-9169
info@shiraev-pllc.com