Office Located in SE Portland
(503) 462-7146
fleur

Please click on the links below to download the forms.

We will review these forms during our first meeting where I can answer any questions you may have. I've provided these forms so that you may review and complete some of the paperwork prior to our meeting.


The Personal Disclosure Statement is a document that talks about who I am, my education, my Counseling Philosophy & Approach, Confidentiality and your rights as a client, and Appointments, fees, and emergency contact numbers.

Personal Disclosure Statement (PDS)


The Adult Intake Form & The Youth Intake Form ask questions about you or your child and why you are seeking-out counseling. These forms review mental and medical health questions including behaviors and symptoms you or your child have or are currently experiencing. This form allows me to have a better understanding of you or your child's health background. Filling out the form prior to our first appointment allows you to take the time to fill out this form, rather than filling rushed and forgetting important information. It also allows us to talk about what is going on and to review any concerns or questions that may arise. I want to make the most of our time together, so the less time you have to fill out paperwork, the more time we have to discuss goals, concerns, and review questions.

Adult Intake Form Youth Intake Form


The Fee Agreement Form reviews the fee for the intake session as well as for individual, couple & family counseling for 50 minutes as well as for 75 minute sessions.

Fee Agreement


Please be sure to contact me if you have any questions.