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Nicole Tabor Counseling

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Reason for care

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1 Appointment info

Reason for care

3 Contact information

What is the reason for seeking care?

Anxiety Attention/concentration difficulties Depression Grief Relationship issues Trauma Other (briefly describe below)

Briefly describe why you are seeking care:

What mental health concerns or treatments have occurred in the past?

Select all that apply

In therapy now In therapy within the past six months In therapy in the past (longer than six months) Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or within the last six months Hospitalized for mental health reasons in the past Known neurologic or genetic disorder 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.

Nicole Tabor Counseling

971.910.4838 |

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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.