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Rising Resilient

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Reason for care

Select date & time

1 Appointment info

2 Prescreener

Reason for care

3 Contact information

Are you a parent seeking therapy for your child/teen?

Yes No

What brings you in to therapy?

These help me understand the themes you want to work on — many clients select more than one.

Anxiety or chronic stress Depression or low motivation Neurodivergence (ADHD, autism, giftedness — diagnosed or suspected) Burnout or executive functioning challenges Trauma or overwhelming experiences Family or parent–child conflict Relationship or communication issues Identity exploration (gender, sexuality, life transitions) Something else

Have you experienced any significant mental health concerns or treatments in the past?

If seeking services for a child/teen, please select anything they have experienced.

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Attempted suicide in the past None of these apply

If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

Rising Resilient

971.356.1698 |

West Linn, Oregon

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THE CLIENT PORTAL IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.