Secure Contact Form

What to expect after you hit submit:

You will be contacted by Tristan, our Virtual Assistant, in order to schedule an appointment. If you prefer to leave her a voicemail, you can do so by dialing 971-350-6474.

First name

Last name

Email address

Phone number

Preferred method of contact:

Preferred clinician

Message

Non-Secure Communications Acknowledgement/Opt-In or Out Consent. By checking the box below I acknowledge: (one of the two checkboxes must be selected as a required field) Please only select one option.

Option 1

Agree to the use of conventional text, insecure email and phone calls. Conventional email is inherently insecure 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

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.

Your information will be encrypted.