Forms for P. Roger Hillerstrom L.M.H.C.

Heritage Registration Form
HIPPA Policies and Practices Form
Disclosure and Permission Form
Insurance Benefit Information
Release of Information Form

New clients register by downloading the forms, printing them, and completing them
In addition to his office at Heritage Counseling Associates, Roger is available to see clients in other locations as well.
On Mondays, Roger is in Snohomish
(Click Here to View the Map.)

On Thursdays, Roger is in Kirkland
(Click Here to View the Map.)
If you will be seeing Roger in Lake Stevens or Kirkland, please bring a copy of the front and back of your insurance card to give to roger so we can bill your insurance company for your visit.
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