Contact Wellspring Counseling To make an appointment or ask a question, fill out this confidential form and click on the "submit" button at the bottom. We will call you by phone as soon as possible, but no later than one business day after receiving your information. First Name * Last Name * Reason for seeking therapy at this time Desired Appointment Days/Times Preferred Location BellevueRedmondEastside (any location)Downtown SeattleRainier Avenue SLake CityWest SeattleSeattle (any location) Who's Being Seen? IndividualChildTeenCoupleOther/Not Sure Date of Birth (00/00/0000) Your Gender Your Phone # * Email Address How did you find us? (optional) How are you planning to pay for therapy? Insurance Out of Pocket Reduced Fee (if qualified) Wellspring EAP Other If using insurance, what is the name of your insurance carrier? If using your Wellspring EAP benefit, what is the name of your company? Is there a specific Wellspring therapist you'd like to see? If so, which therapist? Is there anything else you'd like us to know before we call you?