New Client Interest
I'm so glad that you've reached out! Thank you for allowing me to be a part of your journey. I believe that healing is a collective experience that occurs within relationship. 

I currently have a short waitlist for new individual adult clients. This form helps me keep the waitlist organized. After you submit this form, I will follow-up by email with any questions, potential referral options, and updates on timing. Once I have a slot available, we can setup an initial consultation. I will keep you updated along the way.

I prefer in-person services, although I am also available for telehealth. My regular work hours are Monday through Wednesday, 8:30am to 3pm. I am not scheduling new clients outside of these hours, although some availability may come available in the next couple months.

I'm currently accepting the following insurance: United Healthcare, Optum, Premera, Blue Cross Blue Shield, Regence, LifeWise, Aetna, Tricare West, First Choice Health, Kaiser and Medicare (if your secondary insurance is on the list above). I am not contracted with Medicaid/state insurance and unable to accept this as primary or secondary. My private pay rate is $135 per hour, and I have limited sliding scale slots. I am licensed to practice in Washington state and cannot perform services for a client physically located outside Washington during appointments.

If you have any other questions, please feel free to email me anytime. I try to respond as quickly as possible. 

Shanna Porter, LICSW
Wildflower Wellness Counseling PLLC
(509) 903-6061 (phone)
hello@wildflowerwellness.me (email)
wildflowerwellness.me (website)

Please note: This is NOT a HIPAA-compliant form. By submitting this form, you consent to this communication. 
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Today's Date *
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Name *
Phone *
Email *
What's your preferred method of communication?
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You are the potential client?
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What is your age?
Why are you currently seeking treatment? Please provide a brief history or description. *
When did you begin experiencing symptoms?
Do you prefer in-person or telehealth? *
When are you available for services? (Days/Times) *
What insurance will you be using? *
If you're using Medicare, do you have secondary insurance (Part B, Medigap, etc.)? If so, what provider? 
Do you have Medicaid/state insurance? (If so, I'm NOT able to accept this insurance)
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