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Creative Mind Counseling, LLC

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Reason for care

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1 Appointment info

Reason for care

3 Contact information

What is the reason for seeking care?

Note: Therapist does not provide crisis intervention services (see Contact page for further resources)

Anxiety Attentional difficulties Behavioral issues Depression Grief Relationship issues Substance use Trauma Other

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past None of these apply

If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

Creative Mind Counseling, LLC

503.479.5494 |

Portland, OR

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THE CLIENT PORTAL IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.