Forms

Once you've decided to begin treatment, please complete the appropriate forms below. All forms must be completed prior to scheduling. Adults need to complete the "Adult Information and History Form," while only children and adolescents need to complete the "Child/Adolescent Information and History Form." Everyone needs to complete all other forms.

You may print and fill these out by hand and/or complete them electronically (using the "fill and sign" feature in Adobe Reader or other program of your choice). There are also pre-printed copies available at either my office (2601 25th St SE Ste 420, Salem, OR 97302), or the main Mid Valley Counseling location (2250 D St NE, Salem, OR 97301).

You may return the forms in person to the main Mid Valley Counseling location referenced above, or email the forms to admin@mvcounseling.com.

Contact

Mid Valley Counseling Center

2601 25th St SE Ste 420

Salem, OR 97302

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Tel: 503-364-6093

Fax: 503-364-5121

    Note: by submitting this request, you consent to receive communications from Dr. Kenagy via email.

    © 2019 by Andrew G. Kenagy, Psy.D.