Forms
These are the forms that you will need to bring with
you to your first counseling appointment.
Intake Form - This is the form that we use for your basic
information such as name and address, as well as insurance
information.
Informed Consent - This contains information with regards to
our theoretical approach to therapy, payment information, length of
the counseling session, cancellation policy, and other pertinent
information concerning our office.
Release of Information - Signing this form would allow us to talk
to the person or organization that you authorize us to exchange
information regarding your treatment.
Notice of Privacy - This notice is intended to inform you of our
legal duties, your rights, and our privacy practices with respect to
such information.
Professional Disclosure Statement - This is a mandatory
disclosure from Oregon Board of Licensed Professional Counselors
& Therapists. This will be handed to you at your first appointment.
OTHER:
Credit/Debit Card Authorization Form
you to your first counseling appointment.
Intake Form - This is the form that we use for your basic
information such as name and address, as well as insurance
information.
Informed Consent - This contains information with regards to
our theoretical approach to therapy, payment information, length of
the counseling session, cancellation policy, and other pertinent
information concerning our office.
Release of Information - Signing this form would allow us to talk
to the person or organization that you authorize us to exchange
information regarding your treatment.
Notice of Privacy - This notice is intended to inform you of our
legal duties, your rights, and our privacy practices with respect to
such information.
Professional Disclosure Statement - This is a mandatory
disclosure from Oregon Board of Licensed Professional Counselors
& Therapists. This will be handed to you at your first appointment.
OTHER:
Credit/Debit Card Authorization Form
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Copyright 2007 Pathways Mental Health Services.
All rights reserved.
All rights reserved.
Pathways Mental Health Services
10011 SE Division St.
Suite 312
Portland, OR 97266
Phone: 503.766.3558
Fax: 503.766.3308
info@pathwaysmhservices.com
Suite 312
Portland, OR 97266
Phone: 503.766.3558
Fax: 503.766.3308
info@pathwaysmhservices.com