Thank you for your interest in receiving services through Harbor Christian Counseling Oregon. To begin the intake process, please fill out the form below and click "Submit." Our team will use this information to determine the best fit for your request and will contact you via email within 2-3 business days to follow up. If you have any additional questions, please contact oregonintake@harborcc.us or visit our FAQ page.

Name

First Name

Last Name

Phone

(###)

###

####

Where do you currently live?

Please indicate city/state or country if outside of US.

Type of Service Requested

Briefly describe your reason for seeking counseling services.

Have you experienced a psychiatric hospitalization or other inpatient treatment for related issues within the past six months?

Please list the days and times that you would typically be available for counseling.

Would you like additional information about our sliding fee scale for financial assistance?

Anything else you would like us to know regarding your needs, preferences, or specific requests for counseling?

How did you hear about Harbor Christian Counseling?

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Harbor Christian Counseling Oregon • 1800 Hoskins STreet • Newberg, OR 97132
(503) 877-9616