Let's Talk

Existing Patients

Please use the online scheduler below or access

your patient portal to schedule.

New Patients

Please fill out the form below and I will get back to

you with next steps. I typically reply within 1 week.

Please make sure to check your spam/junk folder if

you do not see a reply.

Name

Gender

Email

Date of Birth * required

Pronouns

Phone

What is the main reason you are seeking treatment?

Please check any of the following that apply to you: * Required

In therapy now

In therapy in the past

In hospital (or IOP) now

Hospitalized for psychiatic reasons in the past

On psychiatric medications now

Taken psychiatric medications in the past

None of the above

. * Required

Current suicidal thoughts

Attempted suicide in the past

Current or past self-harm

None of the above

Please provide additional detail on the above.

Thanks for submitting!

Ashley Bouzis is a psychiatrist, psychotherapist, therapist and yoga teacher in Seattle, WA

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