Michael Galloway, M.Ed., M.A.

Contact

(206) 526-7945
(206) 527-2978

michael@michaelgalloway.com
3417 Evanston Ave N, #410, Seattle, WA 98103

Phone:
Confidential Fax:

Email:
Office Location:

Please fill out the inquiry form below to schedule an appointment and to learn more about my counseling practice. While I do welcome phone calls and emails, this form is the best way to contact me!

Inquiry Form

Name

First Name

Last Name

Contact Name (if different than above)

Relation to Patient

Pronouns

Age

Phone

(###)

###

####

Email Address

How would you prefer to be contacted?

Phone

What concerns bring you to counseling at this time?

Are you planning to use insurance?

I am a preferred provider of Premera Blue Cross. My office will prepare a “Super Bill” (with diagnosis, codes, etc.) for patients who, in turn, may submit charges to their own insurance provider.

Yes

If yes, what is your insurance carrier?

* Please note that email may be used for general information only. Ethical and legal issues prohibit providing information about diagnosis and treatment through email.

Michael Galloway, M.Ed., M.A.

Contact

Inquiry Form

Experienced Trustworthy Engaged Creative Flexible

SERVING THE GREATER SEATTLE METRO AREA