Records Requests
If you would like a copy of your records from ITS, please complete the following form.
Please note that if you would like your records to be disclosed to someone other than yourself or a parent/guardian (if client is under the age of 13), an “Authorization for Use and Disclosure of Protected Health Information” (aka Release of Information/ROI) must be signed before records are able to be released.
To complete a ROI, please fill out the following PDF:
Authorization for Use and Disclosure of Protected Health Information – ROI
This form may submitted to ITS via:
- Email – Scan and attach the document, and send to reception@integratedtherapynw.com
- Fax – 253-564-4409
- In person drop off
If you would like to complete the form digitally, please call ITS at 253-460-7248 and request to have the form added to your Client Portal.
There is a fee associated with Records Requests.
If the client is requesting their own records, it is a flat rate of $6.50.
If someone other than the client is requesting records, the fee is charged in association with WA 246-08-400.
Records will not be released until the fee is paid.
Please allow up to 14 days for processing and redaction from the submission of your records request.
Billing
At ITS, clients must provide credit card information for their account and keep payment information up to date. Statements are sent at the beginning of each month and are due on the last day of the month. Any statement balance not paid by the last day of the month will be charged to the payment card on file. In the instance that the payment card on file declines, a $10.00 late payment fee will be added to the account. Future sessions cannot be scheduled until the balance has been resolved.
Any balance over 30 days past due will be run automatically to the card on file, late payment fee included.
To set up a Payment Plan, please speak to our Billing Department at ext. 107.
ITS does NOT accommodate clients carrying a balance on any accounts after insurance has paid its portion.
Per our Financial Form, you are responsible for notifying us of any changes that affect billing, INCLUDING insurance coverage, subscriber name, or address.
If you lose insurance coverage at any point, you will be responsible to pay the fee for non-covered sessions.
PLEASE NOTE: Co-pays are due at time of service. Co-pays are different than co-insurance.
Helpful Links
My therapist and I aren’t a good fit. What do I do?
No worries! Having a good fit with your provider is essential to a positive counseling experience. If you feel like you and your therapist don’t work as well together as you could, call the front office and let us know. We can transfer you to a different provider in our office who fits your preferences better. Please provide any information you think is relevant to finding a better fit (ex. “I have a hard time starting the conversation, I need someone who will help lead me and get me to open up.” “I need to talk to someone who understand difficulties with parenting.” etc.)
Please note that it often does take some time to get you matched with a new therapist, so there may be a lapse in care during the transfer process. If this is of concern to you, please talk to your current therapist or ask the front office to touch base with them so we can plan for the best way to transfer you. Most therapists will not continue to schedule appointments when you start the transfer process since the relationship is not therapeutically beneficial at that point.

