New Clients - ADHD Child & Family Services

Client's Name *

Your Name (if different from client)

Relationship to Client

Your Phone *

Your Email *

Preferred Method of Contact*EmailPhone

Best time to reach you by phone:*

How did you find out about our services?*

Has the client been diagnosed with ADHD?YesNo

How old is the client?*

Are you looking for medication management or a diagnostic evaluation?YesNo

Would you like to pay with insurance?NoYes

What is the name of your insurance company?*

Is the client currently experiencing a mental health crisis?NoYes

Please note that we are not an urgent, crisis, or emergency care facility. If you are having a mental health crisis or emergency please go to the emergency room or contact your county crisis line. Do not communicate urgent, crisis, or emergency needs or concerns via the new client request form.

Crisis Lines:
Multnomah County Crisis Line (503) 988-4888
Washington County Crisis Line (503) 291-9111
Clackamas County Crisis Line (503) 655-8585

Emergency Walk in Clinics:
Cascadia Behavioral Health (503) 674-7777
4212 SE Division St Suite 100, Portland, OR 97206

Unity Center for Behavioral Health (503) 944-8000
1225 NE 2nd Ave, Portland, OR 97232

Lifeworks NW Hawthorn Walk-In Center: (503) 846-4555
5240 NE Elam Young Parkway, Hillsboro, Oregon 97124

Clackamas County Crisis Center: (503) 655-8585
1211 SE 82nd Ave. Suite O, Happy Valley, 97086.
Clinic Hours: M-F 9:00am-7:00pm, Sa 10:00am-7:00pm, Su closed.

National Talk Lines:
National Suicide Prevention Lifeline
1-800-273-8255
Available 24/7

Trevor Life Line
1-866-488-7386
Available 24/7
An LGBTQ+ crisis intervention and suicide prevention phone service.

Text Lines
YouthLine
Text "teen" to 839863
6:00pm-9:00pm PST

Are you seeking treatment for any of the following concerns?

Violent or aggressive behaviors
Self-harming
Suicidal ideation or attempted suicide
Eating disorders
Fire-starting
Juvenile justice involvement
Drug abuse
History of, or suspected history, of emotional, physical, or sexual abuse

NoYes

How much of a safety concern is this for you right now?*

If you are having a mental health crisis or emergency please go to the emergency room or contact your county crisis line. Do not communicate urgent, crisis, or emergency needs or concerns via the new client request form.

Crisis Lines:
Multnomah County Crisis Line (503) 988-4888
Washington County Crisis Line (503) 291-9111
Clackamas County Crisis Line (503) 655-8585

Emergency Walk in Clinics:
Cascadia Behavioral Health (503) 674-7777
4212 SE Division St Suite 100, Portland, OR 97206

Unity Center for Behavioral Health (503) 944-8000
1225 NE 2nd Ave, Portland, OR 97232

Lifeworks NW Hawthorn Walk-In Center: (503) 846-4555
5240 NE Elam Young Parkway, Hillsboro, Oregon 97124

Clackamas County Crisis Center: (503) 655-8585
1211 SE 82nd Ave. Suite O, Happy Valley, 97086.
Clinic Hours: M-F 9:00am-7:00pm, Sa 10:00am-7:00pm, Su closed.

National Talk Lines:
National Suicide Prevention Lifeline
1-800-273-8255
Available 24/7

Trevor Life Line
1-866-488-7386
Available 24/7
An LGBTQ+ crisis intervention and suicide prevention phone service.

Text Lines
YouthLine
Text "TEEN" to 839863
6:00pm-9:00pm PST

ADHD Child & Family Services

ADHD Child & Family Services

Becoming A New Client

Thank you for your interest in ADHD Child & Family Services!

Step 1:

Step 2:

Step 3:

We look forward to learning more about you!

Please note: We are not an urgent, crisis, or emergency facility. If you are having a mental health crisis or emergency please go to the emergency room or contact your county crisis line. Do not communicate urgent, crisis, or emergency needs or concerns via the new client request form.

Step 1: Watch Our Getting Started Video

Step 2: New Client Request Form

Locations

Administrative Hours

Appointment Hours:

Contact Us