Request appointment | Holistic Healing PDX

Which of our services are you interested in? (Select all services you'd like to discuss during your consultation)

Please complete this pre-screener form to schedule a free phone consultation with one of our clinical supervisors. We suggest you have your insurance card/ID available and complete this form in one sitting so your responses are saved. Note for mobile users: On some mobile browsers, switching between tabs can refresh the page. We encourage you to provide short responses if completing on mobile so the form does not time out! If you're having trouble with the form, please reach out to general@holistichealingpdx.com or call/text 503-862-7797.

Individual counseling Family/Relationship counseling (note:paused for OHP clients, and some insurance plans may not cover conjoint therapy. Check with your insurance directly for details.) If selected, the person whose insurance you plan to use should complete this form. Group counseling (please indicate which group in the next question) Skills Training Case Management Peer Support Not sure Other (please explain in the next question)

What is the reason for seeking care?

A few sentences is plenty. We'll go deeper on the call.

Limited to 600 characters

Are you currently working with another therapist, psychiatrist, or mental health treatment program?

No Yes Recently ended treatment

Have you ever been hospitalized for, recently been recommended for, or participated in a higher level of mental health care?

(For example: residential treatment, inpatient hospitalization, PHP, or IOP)

No Yes I'm not sure

Do you or your loved ones have concerns about your use of alcohol, recreational drugs, or other substances?

No Yes I'm not sure

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