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 and Tuesdays.  We do not accept any insurance and we do not prescribe any type of medication.  

We offer: 

Therapy ($30 per session).  We have a 1-2 month waitlist for therapy at this time.

Assessments ($650 per comprehensive assessment).  Please note we have a 5-6 month waitlist for all assessments and it can take up to 8 weeks for a clinician to call to set up an appointment.

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: *
Would you prefer to be contacted by: *
If you prefer a phone call, may we leave a voicemail?
Clear selection
If you prefer a phone call, what is the best time to call:
Clear selection
Email address: *
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.  
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