Disclosure Statements to Download

Your therapist's Disclosure Statement may be accessed on this page.  
Please print two copies -- one for you and one for Samaritan.  Read the Disclosure Statement, print your name in the space for ‘client name,’ then sign and date the form (in two places) on the last page. If more than one person is coming to counseling, each needs to read and double-sign the last page as well.  Repeat this process on the second copy. Your therapist will sign and return one copy to you.
Notice of Privacy Practices (one copy for you).  You may read this now or later after your first session. Please keep it for your records.

CLINICAL STAFF MEMBERS:
Kay Abramson >
Marti Aitken >
Jim Aultman >
Anthony Barr-Jeffrey >
Bill Collins >
Mary Denny >
Josh Ensley >
Rob Erickson >
Beth Geense >
March Gunderson >
Margaret (Peggy) Hansen >
Toshio Hayashi >
Beth Hess >
Pearle Hintz >
Mark Houglum >
Doug Johnson >
Colleen Kelley >
Ron Kirstein >
Naty Lamug >
Doug LeRoy >
Ada Mak >
Joanna McGuire >
Pat Pedegana >
Anne Perry >
Sebastian Perumbilly >
Michael Rogers >
Beverley Shurmm >
Gary Steeves >
Eric Stroo >
Tita Subercaseaux >
Neal Teng (Disclosure Statement not available on-line)
Lori VanderBilt >
David Wells >
Liza Ziliak > 

LOW INCOME CLINIC PROVIDERS:
Edwin Ferrera >
Jamie Haffner>
Zoe Jenkins >
Sara Joens >
Treesia Kan >
Claire LeBeau >
Carol Lundemo >
Kristen Moss >
Jim Ramsey >
Sarah Rensel >
Leslie Savage >
Kevin Smith >
Deb Thomas >