New Patient Inquiry

Thank you for considering Center Balance for your mental health needs.

Congratulations for taking the steps to better mental health and a better life!


PLEASE NOTE


We do not provide emergency availability, nor are we generally able to accept clients with high acuity or severe mental health problems that would require intensive treatment.


Center Balance does not participate with Medicare, Medicaid, Oregon Health Plan, or in network with any EAP panels. Please review the insurance page for information about which insurances are covered.


Co-pays or fees for service are collected at time of service. A debit or Credit card will be required on file for services.


Accepting Ages 14-65


For ADHD assessment and treatment Accepting Ages 14-65


Appointments are conducted via HIPAA secured videoconferencing. There are some circumstances that may require appointments be conducted in-person (ADHD assessment, controlled substances, hands-on assessments, etc.)


For psychiatry, initial evaluations are scheduled for one 60-90 minute appointment. At the end of the evaluation diagnosis, a treatment plan will be discussed. 


Once your information is received, it will be reviewed and you will receive a response back within one week, or sooner if time allows. Due to your specific needs, provider availability, and other factors, not all those seeking services will be able to be accommodated. If services are not able to be provided through Center Balance, a response letter will be provided with recommendations or next steps.


Use patient legal name below, as it appears on an official, government-issued document or insurance.


Center Balance looks forward to learning more about you, your needs, and is excited to help you with your next step in psychiatric care!




New Patient Intake

We do not provide emergency availability, nor are we generally able to accept clients with high acuity or severe mental health problems that would require intensive treatment. Do you anticipate a need for this level of care?

Contact Information


Insurance Information

Center Balance does not participate with Medicare, Medicaid or The Oregon Health Plan. Center Balance does not take Workman’s Comp. Claims or EAP.   

If patient is not the primary insurance holder please provide the subscriber's name, DOB, and relationship to patient

Do you have any secondary insurance? Please provide details below. Insurance Co., ID# and Group#,  Primary Subscribers name, DOB, and relationship to patient.

Service Information

What are the main concerns or issues you'd like to discuss?

Are you currently taking ANY prescription medications? 

If yes, please list medication name and dose. 

If no, is there a particular medication you are wanting to start or continue?

Privacy Policy

I understand, accept, and agree that this form should not be used to send private health information as it is not transferred via secure messaging. All warranties and conditions with regard to the privacy and confidentiality of information being sent are disclaimed.