Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

See my Disclosure Statement under the Services Provided Tab.
This gives you information about the privacy of your health information

Andrea Masom, LCPC

106 East third St. Suite 2B,
Moscow, ID 83843

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Please do not submit any Protected Health Information (PHI).

Hours of Operation

Monday  

9am to 5pm

Tuesday  

9:00 am - 5:00 pm

Wednesday  

9:00 am - 5:00 pm

Thursday  

9:00 am - 5:00 pm

Friday  

9:00 am - 5:00 pm

Saturday  

Closed

Sunday  

Closed