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1220 SW Morrison Street, Ste. 929
Portland, OR 97205


  • There is a Smart Park garage two blocks away on SW 10th between Yamhill and Morrison.
  • Street parking is available as well. There are often spots available on SW 14th in addition to other street parking in the area.
  • There is a City Center garage across the street and under the church, off of S.W. 12th St.

New Patient Intake Form

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First Name: *

Last Name: *

Date of Birth: *
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Address: *

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Primary Insurance: *

Insurance ID/Policy Number: *

Group ID: *

Name of Primary Insured: *

Birth Date of Primary Insured: *

Relationship of Insured to Patient: *

Financially Responsible for Treatment: *

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I am interested in: * (please check all that apply)

Not Sure YetIndividual TherapyPsychiatric Services/Medication Management

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