Client Forms


CLIENT INTAKE FORM

FILLABLE CLIENT INTAKE FORM

Instructions for FILLABLE Client Intake Form:

1. Open the secure form with password: Rewind123

2. Fill out the form on your device

3. Save to your device

4. Print out and bring with you to your first appointment (or)

5. Email to me at juanimahiatt@gmail.com prior to your appointment

Donate to Mercy Fund

Our Mercy Fund helps us provide services to no- or low-income individuals who otherwise couldn't afford to get the help they need. Processing traumatic memories could potentially mean getting off of PTSD-related disability income!

FIND US

315 E Main St., Suite 304
Hillsboro, OR 97123

PHONE: (503) 332-6416

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