To become a new patient, please do the following:
 
1. Complete the form below in its entirety. PLEASE NOTE: if you are completing this form for a minor, there are sections to fill out YOUR information as well as the minor's. You MUST be the legal guardian to fill this out for the minor. We will request custody paperwork if present in a later part of the intake process prior to scheduling. 

2. Once our referral coordinator receives this form, they will review your form and send you the consent paperwork that must be signed. 

3. Once all consents are signed, our referral coordinator will contact you to schedule an intake appointment. 

***Please have your PCP and/ or most recent psychiatric prescriber fax recent visit notes to 971-239-4271

***We are typically able to schedule intakes within 3 weeks, once all paperwork is completed
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