BHC Client Questionnaire

Thank you for contacting the George Fox University Behavioral Health Clinic.  Our BHC clinicians are graduate psychology students who are overseen by licensed psychologists.  Our Clinic is open Mondays, Tuesdays and Fridays.  We do not accept any insurance and we do not prescribe any type of medication.   We also only see clients at our Newberg, Oregon clinic.

Therapy Waitlist Only ($30 per session).  You can be added to our waiting list by completing this questionnaire, but there is no guarantee you will receive a call to schedule an appointment before our clinic closes.  Therapy is a series of collaborative meetings (usually weekly or biweekly) with a therapist to work toward positive change.

Assessments - We are not accepting new clients for assessments at this time.  Please check back for updates.  

Please answer the following questions and hit submit when done.  


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Are you looking for: *
What would you like to speak to a clinician about? *
Client's Full Name: *
Client's date of birth? *
Client's street address : *
Client's zip code: *
Phone number: *
Email address: *
Would you prefer to be contacted by: *
If you prefer a phone call, may we leave a voicemail?
Clear selection
How did you hear about our clinic? *
Parent/GuardianName (if child is under 18)
Are you the legal parent/guardian of the client?
Clear selection
Thank you for completing this questionnaire.  
Submit
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