Intakes are being schedule as telemedicine appointments until further notice.
Complete the screening form below and mail, email, or fax it to the office as noted below.
*By completing this paperwork, it does not guarantee that you will become a patient of Laurie Muhlbauer, PMHNP-BC. This is to help determine the fit between the individual and provider.
Mail: Laurie Muhlbauer, PMHNP-BC at 910 Capitol St NE, Building C, Salem, OR, 97301
Fax: Laurie Muhlbauer, PMHNP-BC at 855-541-6860.
Adult Screening Form
Teen/Adolescent Screening Form
Please, arrive on time. If you are more than 5 minutes late you may be considered a “no show.”
Minors need to come with parents.