Let’s Connect

Ready to request your first intake session? Please fill out the form below and we’ll get in touch within 24 business hours to schedule your first appointment.

Appointment Request Form

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Do we have permission to contact you?

How would you prefer we get in touch with you?

Do we have permission to leave a voicemail for you?

Scheduling Preferences

Optional

Are you aware we are Telehealth only at this time?

Yes! Telehealth works for me/us.

No, I did not. I have some questions and I would like someone to explain how it works for telehealth services.

How did you hear about us?

How will you be paying for services?

Office Address

Wellness PNW Counseling

Portland, OR

For general information, you can email us at hello@wellnesspnw.com or fill out the contact form above with a brief message, and we will get back to you within 24 hours to determine next steps.