Suzanne Apelskog of Life's Learning, PLLC

Billing & Payment

Payment method

How do you plan to pay?

Is there a specific Life's Learning counselor you hope to meet with?

If you have insurance you hope to use, please list the name of the insurance carrier

If you have a deductible or copay with your insurance, what is the deductible and copay? It is recommended that you call your insurance carrier to understand your benefits, specifically for mental health.

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Client Preferences

Preferred appointment times, Monday through Friday?

Morning Afternoon Evening

Would you prefer in office or telehealth appointments?

What is your reason for seeking services?

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Are you open to meeting with a graduate/master level intern?

Yes No Maybe if it is for a low fee or free Maybe. I would like more information

Please list your scheduling needs, Monday through Friday (no weekend appts available)

Please list preferred days and times that you are available.

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The office is located in North Spokane on Francis Avenue. Does this location work for you?

Reason for care

Where are you located in Washington?

Is there substance use issues, past or present (including treatment)?

Please specify

Are there any legal issues (including CPS) that cause you to seek treatment?

If yes, please specify

Are there any past or suspected diagnoses?

Please specify

Are you seeking counseling for yourself or someone else?

Please specify

For couples counseling requests, has there been any substance use concerns, abuse or domestic violence or infidelity (active or past)?

Please specify.

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With child counseling requests, are both parents in the household? If no, is there a parenting plan in place for health care needs?

Please specify

With teens over the age of 13, they are the age of consent for counseling. If you are a parent seeking services on their behalf, are they invested in seeking services themselves?

Please specify

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.

Who would be receiving care?

Your info