Make an Appointment: (503) 757-1676 | jennietownecounseling@gmail.com

Home
About
Services
- Individual Counseling
- Couples Counseling
Getting Started
Resources
Contact
Blog

Client Forms

If you are new, please fill out these intake forms before the first session.

Client Intake Form

Information Sheet

Limits of Confidentiality

6124 SE Milwaukie Ave

Portland, OR 97202

jennietownecounseling@gmail.com

Send Me Your Question

Name *

E-mail *

Phone

Comment or Message

Terms of Use *

Yes, I want to submit this form

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Name

Contact Info

6124 SE Milwaukie Ave

Portland, OR 97202

jennietownecounseling@gmail.com

Privacy Policy | Website by Brighter Vision