PSP Appointment Request

This form is secure and HIPAA compliant

 Please fill out all sections completely so we can place you with the right clinician!


Please type "I agree" or N/A if you accept this legal requirement.
We don't provide crisis care as we don't have full-time staff, but we can provide referrals if we are unable to treat you.
Providing as much detail as possible helps us to match you with the best clinician for your needs. Thank you!

If your form does not allow you to click and submit, check your entries above - there are a few required fields such as email, type of services requested.

Puget Sound Psychotherapy & Psychiatry, PS

2719 E Madison Street, STE 300, Seattle, WA 98112

206.669.4336

www.PSPseattle.com