Blue Leaf Mental Wellness Client Inquiry

Thank you for reaching out. We’re glad you’re taking this step. Finding the right clinical fit is an important part of care, and we want to make sure we can meet your needs appropriately.

Our practice provides outpatient psychotherapy for individuals who are able to remain safe between sessions and are not currently in need of crisis or intensive level-of-care services. If you are in immediate danger or experiencing a mental health emergency, please call 988 or go to your nearest emergency room.

Please take a few minutes to complete the form below so we can determine whether we are the right fit for your care needs.

We do our best to respond within 2 business days, pending clinician availability. Keep an eye out for an email from clientcare@blueleafcenter.com and please check your spam folder.

📍 Please note: We are licensed in Washington State. If you live outside of WA, in-person sessions at our Vancouver, WA office would be required.

We appreciate your patience as we personalize your care!

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Your Name  *
Email
 *
Phone number (Only provide if it's ok for us to leave a VM message)
Client date of birth. (Please note we only work with adults 18 years and older.) *
Please indicate which services you are open to. (Please note that Telehealth services require you to be physically located in WA state at the time of your appointment due to licensing laws.)
Preferred method of contact? Please only provide phone number if it's ok for us to leave a voicemail message.
 *
Required

Please note that we are in network with only a handful of insurance companies, they are:

Kaiser NW

Regence BCBS (excluding Legacy LHP plans) 

Aetna (excluding Medicare Advantage)

Lifewise/Premera

Moda 

(Insurance companies require a diagnosis in order to pay for your treatment.)


Insurance cannot be use for our pre-licensed therapists (intern). Insurance CAN usually be used with Associates if we are in network. You would check network status with your insurance company under Tara May, not the Associate's name.

If we do not accept your insurance, you understand that you would pay for our services directly. We can provide a superbill when requested for you to use with your insurance. 

We do not accept LNI or EAP.  

We are NOT in network with: 

First choice

Molina

Cigna 

Pacific Source Medicare 

Aetna Medicare plans

Regence Legacy LHP plans

Providence 

United Healthcare

L&I (workers compensation)

Medicare

Pacific Source as of 1/1/26


What insurance were you planning to use?
Our practice provides outpatient psychotherapy for clients not in acute crisis. If you answer yes to any of the following and are seeking ongoing care, we recommend a higher level of support such as intensive outpatient (IOP) or crisis services (call or text 988). 

Please check all that CURRENTLY apply. *
Required
To help us find the right therapist for you, please select all the areas that apply right now that would help us make the best match.

Please note: We are not a crisis facility. If you are in immediate danger or need urgent support, please contact 911 or Southwest Washington Crisis Line at: 800.626.8137
Therapist Preferences: Please check all therapists with whom you would be open to working with. Please note that all of our therapists are trained in EMDR and Flash Technique.  Availability has been updated as of 6/2026
Courtesy Insurance Check: If we are in network with your insurance, we may be able to check your benefits as a courtesy, however you are expected to check your benefits directly with your insurance company as you are more likely to get accurate information for your financial responsibility. If you'd like us to try, please include all of the following:  member ID number (include all numbers and letters), DOB, and Insurance name. 
Are you seeking (adjunctive) EMDR treatment and have a current non-EMDR therapist? (Please note that we will require a release of information to speak with current therapist in order to provide adjunctive EMDR treatment.) *
Are you seeking couples/family therapy? *
Where did you plan on attending your telehealth sessions from? *
Please acknowledge that by selecting the checkbox below, you recognize that this form does not guarantee the provision of services due to factors such as limited availability, insurance coverage, and the specific reasons for seeking services. *
Required
By submitting this form, you agree to the transmission of your information through the internet to our records. We strive to safeguard your information to the best of our ability, as with any other internet-based system. *
Required
Do you require any specific accommodations? PLEASE NOTE THAT OUR OFFICE IS A HISTORIC BUILDING AND NOT ADA ACCESSIBLE. TELEHEALTH IS AVAILABLE. *
Is there anything else you'd like us to know including specifics around your scheduling preferences?
How did you hear about us? *
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