Client Intake Form

The intake form is a multi page personal assessment. When completed and reviewed during your first visit, it will help both of us develop a strategy for exploring and resolving concerns and issues that are on your mind.

Please take a few minutes to download the intake form  and fill it out. While there are a number of evaluation questions, you only need to fill out those that apply to you.

New Clients must also download Registration Packet 

I would appreciate it if you would bring the completed forms to our first visit.

You can schedule your visit by calling my office at: 509.466.6632

Please secure your visit time by prepaying with our secure payment system… Thank you.



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New Client Interview

ONLY required once. New Clients are encouraged to Pre-Pay for their first interview session to protect their time slot.

Download files needed Registration Packet  

Appointments scheduled for you are set aside expressly for you, therefore any not kept will be billed unless canceled 48 hours in advance.

Dr. Ray Smith


Ray Wm. Smith, Ed.D
9507 N Division Street Suite A
Spokane, WA 99218-1556

Phone: (509) 466-6632
Fax: (509) 466-0117
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Office Hours:
Monday - Friday, 8 a.m. - 8 p.m.
Saturday Mornings