Talking Twenties

For your convenience, we provide all services exclusively by telehealth (video).
We can only provide mental health services to residents of Oregon or Washington. Coaching can be done from anywhere!

Thank you for your interest in Talking Twenties! The information below helps us understand if we are good match for your goals.

For more details on the services we offer and our providers, please visit our website.

Your information

First name

Last name

Email address

Phone number

Talking Twenties may contact me by:

Phone

Text

Your name

Your goals

What are you looking for?

Medication

Therapy

Professional/Academic Coaching

What is your due date?

When did you give birth?

Other issues not included above

What are your goals in therapy? What do you hope to get out of working together?

More details help us pair you with the right therapist.

Coaching goals

Please include what you hope to get out of working together.

Marisa sees clients in Oregon and Washington. She is in-network with BCBS, Regence/Premera, PacificSource, Moda & Aetna.

Kelly sees clients in Oregon and Washington. She is in-network with BCBS, Regence/Premera, PacificSource, and Moda

Would you like a family member to be involved in your care?

Billing & Insurance

Scheduling & Appointments

Medications or Treatment

I will manage my treatment alone.

Your details

Date of birth

We are only able to see clients age 14 and up.

Unfortunately we can only see clients residing in Oregon and Washington at this time!

Current medications

Please include all prescriptions you are currently taking.

Has a mental health professional ever given you a diagnosis?

Please note: Because of federal telehealth laws, we are unable to prescribe controlled medications used for ADHD (e.g. Adderall, Concerta, Vyvanse, Ritalin) or anxiety (e.g. Xanax, Ativan, Klonopin, and Gabapentin).

I understand Talking Twenties cannot prescribe controlled medication.

Have you ever been to the hospital or emergency room for a mental health reason?

Yes No

Why were you hospitalized?

Suicide attempt

Suicidal thoughts

Unusual or odd Behavior

Mania

Psychosis

Eating disorder

Something else

Other reason for hospitalization

What were the approximate dates of your hospitalization(s)

Insurance & Payment

In-network coverage varies by provider. At least one provider is in-network with: Blue Cross Blue Shield, Regence, Premera, Pacific Source, Moda, and Aetna.

For other insurance plans, we can provide a receipt of services for you to request reimbursement from your insurance company. Insurance will not cover coaching services.

Due to federal restrictions, we cannot see people insured by Medicaid, OHP, or Apple. This includes Medicaid plans through PacificSource and Blue Cross Blue Shield.

I confirm I am not insured by a Medicaid insurance plan.

If you're using insurance, upload a picture of the front and back of your insurance card. We cannot confirm your appointment without a copy of your insurance card.

Add file

Please upload a file

We'll need a copy of your license or identification

I'll upload now. I'll email to contact@talkingtwenties.com

Please upload a copy of your license or identification

Add file

Please upload a file

This person will receive billing-only access to the client portal to make payments.

This is okay with me. I would like to arrange another way to pay for care.

Additional information

Is there anything else we need to know before scheduling your first appointment?

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