New Client Request Form

Please NotE

Please be aware that our clinic does not participate with Medicare, Medicaid or The Oregon Health Plan. Not all therapists are in network with the same insurance companies. See our Insurance page for information about the specific providers.

While we do bill to insurance companies a provider is in network with, we currently do not bill out of network insurance companies but are happy to provide you a bill that you can submit to your insurance company directly. We are not in network with any EAP panels.

Many clinicians are in the office part time. Clients who require emergency services may be better served by another clinic where these services are available. 

Once your information from the form below is received, it will be reviewed and we will do our best to respond as soon as we are able. 

For psychiatry, initial evaluations for adults are scheduled for one 60-90 minute appointment. Initial evaluations for children and adolescents are often split into two separate 60 minute appointments: parents and caregivers are seen alone for the first appointment. This is followed by the second appointment in which parents/caregivers and child/adolescent are seen together. At the end of the evaluation diagnosis and a treatment plan will be discussed. 

Please complete the form below. The information will allow us learn about you and your mental health need. You will be contacted and an appointment may be scheduled. 

Due to practitioner availability, your specific clinical needs, and a number of other factors, we are not always able to accept everyone seeking services. Please accept our apologies in advance.

We will contact after we have had a chance to review the information submitted here. Thank you!