600 Oakesdale Avenue SW #104 Renton, WA 98057: (425)-228-5336 | 5837 221st Place S.E. Issaquah, WA 98027: (425) 391-0887 |

All Other Locations: (206) 420-5416

|

WA-Reception-RVP@LifeStance.com

P. KELLY BOUNKEUA, Ph.D.

P. KELLY BOUNKEUA, Ph.D.

Here are the forms and disclosure statement for you to be seen at River Valley.
Please complete the forms and print them out and bring them to your first appointment.

Disclosure Statement
Billing Info Form
River Valley Benefit Verification Form
Privacy Notice Form
Financial Policy
Financial Policy for Minors

Adult Checklist of Concerns (2)

Child Checklist of Characteristics

counselingbooklet
Electronic Privacy Addendum