Contact

Contact Us

Please submit the form below and we will be in contact to set up a phone consultation and schedule your assessment.
[email protected]
503-308-8016

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First & Last Name *

Email *

How did you hear about us? *

Name of person or agency who referred you. *

What brings you to therapy? *

Please briefly explain what you're hoping to address in therapy

Are you a First Responder? *

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Phone Number *

Payment Options *

I Need to use my Insurance Out of Pocket is an option

Insurance *

If you NEED to use your insurance, please choose your insurance option below

Your availability for sessions *

Please share when you're available for sessions

Therapist Preferences *

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Preferred Method of Contact *

Phone Call - Voice Message Email Text Message

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