forms and payment


If you are a new client, please complete the following forms, email, mail or fax them to me no later than the evening before your appointment.  If you are unable to send them in advance, please bring them with you to our first appointment.  If you plan to use insurance, please also bring your insurance card – or a copy of it – to the first session.

All forms are in PDF Format. (Get the free Adobe Reader)

Rates for 2020


My services may be covered in whole or in part by your healthcare insurance plan. Insurance can be complicated: please feel free to contact my billing service, River City Billing, at 503-287-2171, for more information about your coverage.

I am on the following healthcare insurance panels:

BlueCross BlueShield (Preferred Provider)
Choice Care Network
Corphealth, Inc.
Healthcare Direct
Kaiser Permanente
First Choice Health Network (FCHN)
Pacific Source

Other healthcare insurance plans not listed here may offer “out-of-network” mental health benefits. You can learn more about this by contacting your insurance plan or by having my billing service look into this for you.


Payment is due at time of service unless another arrangement has been made with me.

Accepted payment methods: