First Visit Forms

Art by Gustav Klimt​

​​​Alsept Psychiatric LLC 

These forms need to be filled out, scanned and faxed or attached to an email to preferably within 2 business days after making your appointment. The "Insurance Verification Form" can only be filled out by calling your insurance company.  Only a customer service representative can provide up-to-date information on your mental health benefits in the form of an interview you will take the customer service representative through.   It covers in and out of network benefits and deductibles as well as regular co-pays and co-insurance questions.  In addition to sending these forms to Ms. Alsept in advance of the visit, if you will be using insurance to pay for your treatment please also send a copy front and back of your insurance card. When patients see other specialists, the provider has office staff who call in advance to check on these benefits.  In private practice psychiatry this is rarely the case.  And because patients, not their insurance companies, are ultimately responsible for the cost of their own medical care, Ms. Alsept has patients call about their own benefits so they know what, if any, out of pocket expenses they will incur.  

If these forms are not submitted at least 2 business days before first visit, patient's appointment may be canceled. Patient will be notified.


​​3436 NE 45th Street

Seattle, WA  98105

Phone:  206.240.5584
Fax:  866.453.0617


Days: Tuesday - Friday