Auto Bill

Bhramari Seattle uses the third party vendor Square Up for those who choose to pay online by credit/debit. For this service, Square Up takes an additional service charge. I am happy to handle billing for you and charge the card you have saved to Square Up for your convenience. This transaction will be processed within 48 hours of your session. Please note you will see an additional "$1 service charge" on your receipt.

You may also choose to pay online through individual invoices. You will receive an invoice via email within 48 hours of your session and you can pay online. There is no service charge to you to do so. 

Auto Bill Form

 

New Client Forms

Hello there. Thank you for your interest in my practice. Therapy is an investment of your time, energy, and money, you are welcome to schedule a free 30 min consultation at my office. This provides you with an opportunity to meet me and see the space before you make any decisions. I believe genuine care is a birthright for everyone, I offer a sliding scale for students and those with financial barriers. Inquiring about a reduced rate will not lessen your quality of care. Please contact me to set this up.

Below you will find all the forms as individual PDF files that are available for download. You may complete the New Client Intake form and return via e-mail or you may bring a printed copy to your first scheduled session. The rest we will sign and review together. I acknowledge that these forms are personal and the information I am inquiring about may be of sensitive nature. Please know we can do this first step together if that would be more comfortable for you. I will have forms ready for our first scheduled session and we can spend our time completing and reviewing them.

Release of Information

HIPAA Notice of Privacy

Disclosure Statement

New Client Intake

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Melissa Myers

M.A., LMHCA, CMHIMP, CCTP, RYT