New Client Inquiry Form

We will contact you within two business days of receiving your request. If you have any questions, please feel free to call our office 503.778.0787 or email our front desk office@KelleDeBruin.com.

If you are reaching out to schedule therapy for a child who is 14 or younger, please be aware that our practice focuses on collaborative family therapy with children. This means that parents and guardians must be able to willingly consent to participating in assessment and therapy as determined by the client’s needs.

Our clinicians are able to accept most parts of the Oregon Health Plan and Moda Health Insurance. Private (cash) pay options range from $100-$175 per session.

Existing Clients

Established clients can click button below log in to their client portal.

Client Portal

Name

First Name

Last Name

Contact Person Name (If different from New Client Name)

Email

Phone

(###)

###

####

Birthdate

MM

DD

YYYY

What services are you interested in?

Individual Therapy

Family Therapy

Child Therapy

Couples Therapy

Sex Therapy

I'm interested in?

In-Person Therapy Only

Virtual Therapy Only

In-Person or Telehealth Therapy

If you are interested in couples therapy, please provide your partner’s legal first and last name, email address, and phone number below.

Partner's Legal First Last Name Partner's Email Address Partner's Phone Number

Which payment option are you planning to utilize?

Insurance Carrier (If Applicable)

Insurance Member Number (If Applicable)

What is your current availability for sessions

What are you hoping to accomplish in therapy?

How did you hear about us?

Let’s Connect!

New Client Inquiry Form

Existing Clients