Your Song Counseling, PLLC - Ayako Aizawa, MS, LMHC, GMHS

Your Song Counseling, PLLC - Ayako Aizawa, MS, LMHC, GMHSYour Song Counseling, PLLC - Ayako Aizawa, MS, LMHC, GMHSYour Song Counseling, PLLC - Ayako Aizawa, MS, LMHC, GMHS
  • Home
  • Specialty & Bio
  • Treatment Approach
  • Rates & Insurance
  • Contact
  • 日本語(Japanese)
  • Forms
  • Teletherapy
  • More
    • Home
    • Specialty & Bio
    • Treatment Approach
    • Rates & Insurance
    • Contact
    • 日本語(Japanese)
    • Forms
    • Teletherapy

Your Song Counseling, PLLC - Ayako Aizawa, MS, LMHC, GMHS

Your Song Counseling, PLLC - Ayako Aizawa, MS, LMHC, GMHSYour Song Counseling, PLLC - Ayako Aizawa, MS, LMHC, GMHSYour Song Counseling, PLLC - Ayako Aizawa, MS, LMHC, GMHS
  • Home
  • Specialty & Bio
  • Treatment Approach
  • Rates & Insurance
  • Contact
  • 日本語(Japanese)
  • Forms
  • Teletherapy

Intake Forms

My recommendation is to ask me for an access to portal to complete the paperwork online.  However, you can certainly download intake forms (ALL of them!) below to complete and bring to your intake appointment.  You can swing by my office to pick them up as well.  If you prefer to work on them at the appointment, please show 30 minutes early.

Notice of Privacy Practices (pdf)Download
PHQ-9 & GAD-7 (pdf)Download
Intake Questionnaire (pdf)Download
Disclosure & Informed Consent for Teletherapy (pdf)Download
Financial Agreement (pdf)Download
Acknowledgement of Receipt of Notice of Privacy Practices (pdf)Download
Counselor Disclosure (pdf)Download

Contact

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Ayako Aizawa, MS, LMHC, GMHS

2711 North 21st Street, Tacoma, Washington 98406, United States

(253) 242-2795

Hours

Mon

09:30 am – 03:00 pm

Tue

09:30 am – 03:00 pm

Wed

09:30 am – 03:00 pm

Thu

09:30 am – 03:00 pm

Fri

Closed

Sat

Closed

Sun

Closed

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