Getting Started:

New patient intakes are currently available.  Intakes are being schedule as telemedicine appointments until further notice.

To schedule a new patient intake appointment:

1. Complete the form below and mail or fax it in.

The form can be mailed to:

Laurie Muhlbauer, PMHNP-BC at 910 Capitol St NE, Building C, Salem, OR, 97301 or faxed to Laurie Muhlbauer, PMHNP-BC at 855-541-6860. 

Do not email this since email is not encrypted and secure.  Email will not be responded to because of this.

                                                                                           Adult Screening Form

 

 

                                                                             Teen/Adolescent Screening Form

For intakes:

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.

***If you are having an immediate life-or-death emergency, call 911***

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