Application Screening & Intake Packets
Client Screening Application Packet
- Client File Signature Packet client signiture packet
The Attachment Project: Learn Attachment Theory from Experts
Attachment Styles Test: Attachment Style Quiz from Dr. Diane Poole Heller
Life Events Checklists
· LEC-5 (standard self-report) (PDF)
· LEC-5 (extended self-report) (PDF)
· LEC-5 Interview (with abuse ratings) (PDF)
Brief Trauma Questionnaire
Brief Trauma Questionnaire (va.gov)
Trauma screening (symptoms) Questionnaire
o Email Client Information Packet
o Email Client Intake Application
o Client returns application with non-refundable intake Fee $75
o Clinician calls for an introduction interview. If both agree to a working relationship
o Note: If relationship/group or family sessions, all persons must complete their own paperwork and submit it prior to moving to the next step. ***
o Email Client File Packet
o Client Completes Signature Pages
o Email Client Questionnaire(s)/ Assessments
o Client Completes Proposed Questionnaire/Assessments
o Client Returns signed file packet, questionnaire, and assessments to the clinician.
o Client pays $125 flat fee non -refundable Assessment Compilation. Each assessment has an additional fee to complete the report
o Clinician Compiles assessments reviews
o Clinician calls client for treatment interview 1st or 2nd face-to-face meeting
o Clinician and client Work on Treatment Plan.
Individual Sessions: Coaching $100 an hour; Trauma Counseling $150 an hour; Insurance in Oregon Potential. (Pacific Source) Sliding Scale Fee negotiable.
Couples Sessions: Prepare & Enrich (10-12 sessions)- $125 an hour. Other expenses include the assessment fee and workbook paid to the Prepare & Enrich Program.
Group fees as described per group
Other fees that may apply include but are not limited to mileage, copies, phone/email communication, additional assessments, assessment reports, resource workbooks.