Puyallup Child and Teen Therapy Send Message

Who would be receiving care?

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Reason for care
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Administrative
How did you hear about Puyallup Child and Teen Therapy?
Billing & Payment
Should we work together, how would you prefer to pay for your child's therapy services?
If you are hoping to use your insurance, what is your insurance plan? (For example, Premera BCBS. Write N/A if not applicable.)
Client Preferences
You can also use this space to clarify any of your above answers from this form.
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For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.