Contact Form



What to expect after you hit submit:

You will be contacted by our Intake Coordinator Allen Wright. You will be informed if the therapist you have identified has openings, or if there is a waiting list. If you prefer to leave Allen a voicemail, you can do so by dialing 971-350-6474. Faxed referrals can be sent to 888-971-4017















 




















Details regarding Non-Secure Communications Acknowledgement/Opt-In or Out Consent.

 

Option 1: Conventional email and text: Agree to the use of conventional text, unsecured email and phone calls. Conventional email is inherently unsecure and therefore poses a risk to the privacy and security of my Protected Health Information. I accept these risks and consent to Shoreline Counseling, LLC's therapist’s and office staff communicating with me via unsecured email with regards to scheduling, billing, and payment for healthcare services. I am not required to give this consent in order to receive treatment.

 

Option 2: Secured Only: Contact will be made only through secure email, portal messaging and phone calls. I only wish to be contacted via secure communication means, or at the phone number provided, until such time as I may elect to make a request for communication via non-secure means.