Forms
Helpful Forms
Established Patients forms:
Fill the following forms to prepare for your your appointment:
PHQ 9 and GAD 7
BDI: Beck Depression Index
HERO Wellness Scale
WHODAS- WHO Disability Assessment Scale
Controlled Substance Agreement
New patient Forms:
If you're a new patient, please complete the following forms and bring them to your first session.
New Patient Questionnaire
Confidentiality Agreement
HIPAA Authorization Form
Release of Information Form
Referring Provider Forms:
TMS Form
New Patient Referral
Controlled Substance Agreement
READY TO BEGIN YOUR JOURNEY?
Shifa Health has been the go-to center for the best integrative mind care in the area since 2003. We are a group of highly skilled Psychiatrists, Psychiatric Nurse practitioners, Psychologists, and Counselors who are passionate about enriching your mental health and wellbeing.
QUICK LINKS
CONTACT INFO
EVERETT / SILVER LAKE
10333 19th AVE SE , Suite 109,
Everett, WA 98208
CALL : (425) 742-4600
FAX : (425) 225-6859
MOUNT VERNON
1103 CLEVELAND AVE,
MOUNT VERNON, WA 98273
CALL : (360) 336-6868
FAX : (360) 336-6866
LOCATIONS
OPENING HOURS
Monday
8:30am-5:00pm
Tuesday
8:30am-5:00pm
Wednesday
8:30am-5:00pm
Thursday
8:30am-5:00pm
Friday
8:30am-5:00pm
Saturday
Closed
Sunday
Closed
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