Name:
Email:
Phone:

Insurance Plan Name (ex. Regence Blue Cross, Aetna, etc...):

To see a list of insurance plans we currently accept, click here.

Therapist Preference: None Jamie

Message:


Fill out the Confidential Health Intake Form, save a copy for your records
and attach a copy to this email. Or you may fax it to us, or drop it in the
mail. If you are faxing your forms please call ahead so we can ensure
that we are ready to recieve your forms.

Fax: 360-834-1886
Mail: 222 NE 4th Ave
Camas, WA 98607

Please allow 24 hours for email response.
To expedite your request, please call 360-834-1886