NEW PATIENT INTAKE

(School-Based Services)

What services are you interested in? (Check all that apply)

Individual Counseling

Family Counseling

Group Counseling (social kills, grief, emotion regulation, etc)

Thank you! We will be in touch shortly. Appointments will be scheduled based on priovider's availability.

Pacific Northwest Behavioral Health, LLC

971.258.2120 Pharmacy Inquiries: 503.432.0216

971.200.2719 F

6600 SW 92nd Ave, Suite 350, Portland, OR 97223

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