Ready

when you are.

You don’t need the perfect words or a full game plan—just a starting point.

Fill out the form below with whatever you’ve got. Messy thoughts welcome. We’ll schedule a free 20-minute consultation with me—I’ll answer your questions and you can decide if I’m the right therapist for you.

Name

First Name

Last Name

Date of Birth

YYYY

Phone

(###)

###

####

Are you planning on using insurance?

What’s been kicking your butt lately?

(I mean that in the most compassionate way possible.)

What days work for you

Monday

Tuesday

Wednesday

Thursday

I'm Flexible

NOTE: By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Katie Sporing Kovach harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

**If you are filling out this form for someone else, please fill in with the information for the person who will be receiving services. You can add your contact information in “What is kicking you butt lately?” once that section is filled out.

If you're experiencing a crisis and need immediate support, please use one of the following resources or go to the nearest emergency room:

Multnomah County Crisis Line:   503-988-4888  
Washington County Crisis Line: 503-291-9111  
Clackamas County Crisis Line:   503-665-8585
National Crisis Text Line

Ready

when you are.

IN BOUNDS PDX