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Poyama Counseling Services
Therapy for Children, Individuals, Couples, & Families
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You're one step closer... to a brand new you.
New Patient Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

Adult Intake Information
Adult History and Current Concerns
Notice of Privacy Practices (Adult)
Consent Form
Tele Health Consent Form

Child Intake Information
Child Developmental History and Past Health
Notice of Privacy Practices (Child)
Consent Form
Tele Health Consent Form

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Poyama Counseling Services
503-588-2004
965 Liberty Street SE
Salem, OR 97302


[email protected]

Proudly serving Salem, Polk County, Marion County, Yamhill County, Keizer, Albany, Dallas, and Woodburn, OR.


Services provided include Individual Counseling, Therapy for Children, Couples Counseling & Relationship Problems, Family Therapy, and Therapy for Trauma.
 

Helpful Forms

Get your paperwork filled out before you arrive.



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