Licensed Professional Counselor
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Helping people to heal and grow in their lives.

Intake Forms

Below you will find links to four Intake Forms and instructions for each form:

  1. Client Information – please print, complete, and bring this form to our first session.
  2. Professional Disclosure and Informed Consent – Please print and sign this form and bring to our first session. Please also print a copy for yourself or request a hard copy of this document from me at any time.
  3. Communication Policy - Please print and sign this form and bring to our first session. Please also print a copy for yourself or request a hard copy of this document from me at any time.
  4. Notice of Privacy Practices – Please print a copy of this document for yourself or request a hard copy of this document from me at any time. This document includes (on page 3) an ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES (HIPAA) document. Please sign and bring this “acknowledgment” form to our first session.

For Counseling in Portland, feel free to call me today at (503) 887-3309, email me, or use my Contact Form to book a counseling session or to set up a FREE consultation.

Office located in NW Portland, Oregon. Serving the Portland metro area, including Beaverton, Hillsboro, Lake Oswego, Tigard, West Linn, Milwaukie, Oregon City, Tualatin, Gresham, and Vancouver, WA.

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