Forms & Policies
This page has information and resources for existing clients.
Forms
Please print, complete, and bring these forms to your first session.
- Client Information Form (pdf)
- Disclosure-and-Service-Agreement (pdf)
- Intake Questionnaire (pdf)
- Primary Insurance (pdf)
- Secondary Insurance (pdf) Use this form if you’d like me to bill a second insurer.
Policies
Confidentiality
Except in certain legal situations (see Disclosure and Service Agreement), our sessions are entirely confidential. For more details, see the following document: Notice of Privacy Practices (Word)
Appointments/Cancellation
If you are unable to keep an appointment, please call to cancel as soon as possible. Sessions not cancelled at least 48 hours in advance will be billed at the full rate. Insurance will not reimburse a missed session, so you will be responsible for the full fee.
Insurance
I am an in-network provider for Premera, Regence, Lifewise, First Choice, most Blue Cross Blue Shield, and other insurance networks. I am able to accept payment from any insurance company. To determine exactly what your insurance will pay, call your insurer and ask at what rate they will reimburse services by Sharon Eiler, Licensed Marriage and Family Therapist for (Individual) CPT codes 90806 and 90808. Sessions with another person (such as a spouse or child) are often covered: CPT code 90847. Ask how many sessions you are allowed, the maximum allowable amount, what your copay is, and if there is a deductible you must first meet. Insurance report of benefits are typically accurate but not final, and you are ultimately responsible for payment.
