Contact Me

 

To schedule an appointment, please provide your contact information via the form on this page.

 

Telehealth (audio/video) sessions are also available.

 

Office Address: 110 E. Historic Columbia River Hwy, Troutdale, OR 97060



View Larger Map

 

    Your Name (required)

    Your Email (required)

      *May we email you?  

    Your Phone (required)

      *May we leave a message? 

    Your Insurance Provider


    Subject

    Your Message


    ** Please note: Email correspondence is not considered to be a confidential medium of communication **

    Email sent over the internet is not secure and should not be used to communicate confidential and/or health information directly. Please be aware that Attentive Counseling cannot guarantee the confidentiality or security of any information you send to us over the internet when using email. Attentive Counseling shall not be liable for any breach of confidentiality resulting from such use of email via the internet.

     

    HIPAA Privacy Notice

    Professional Disclosure Statement

    Telehealth Informed Consent Form

    New Client Intake Form

    PHQ-9 GAD-7

    Confidential Information Release

    Download/Print All Combined

     

     

    ** Note about sending me your completed forms:  If after reading the above disclosure about email confidentiality you still prefer to send your forms via digital means instead of sending them to my PO Box; then, the links below will prove to be more secure options of sending these forms than via standard email.

     

     

    https://signal.org

    https://protonmail.com

    https://tutamail.com

    https://www.mailvelope.com

    https://delta.chat/

     

    PDF Annotation (Offline app)