Helpful Forms & Privacy Information(2)

If you're a first-time client, please review and complete the following forms, and send them to us via fax (1 503-765-1931), encrypted email or via USPS.  If we are meeting in person you can bring them to your first session .

• Client Intake Form
• Limits of Confidentiality/Cancellation Policy Form
• Professional Disclosure Form
• Policy Information Form
• Informed Consent for In-Office Sessions
• Informed Consent for Teletherapy Sessions
• HIPAA Notice
• Good Faith Estimate Notice
• Anxiety Questionnaire
• Depression Questionnaire
• Adverse Childhood Experience Questionnaire

Client Intake Form

Confidentiality and Cancellation

Professional Disclosure and Fee Agreement    Office Policy Agreement

Informed Consent for In-Office Sessions   Teletherapy Health Informed Consent    HIPAA Notice   Please read before your first session   Good Faith Estimate Notice   Please read before your first session

Anxiety Questionnaire Please complete this and bring it to your first session

Depression Questionnaire Please complete this and bring it to your first session

Adverse Childhood Experience Questionnaire Please complete this and bring it to your first session

If you would like me to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), complete this form:

• Consent to Release Information Form

Release of Information