Dina Yerex, LPC, CADC III, CGAC II
Counseling for Individuals, Couples, and Families
Forms
Before your first appointment, please download the forms on the left below, choosing the Disclosure Statement for the office for which you are scheduled.
New Client Forms:
Client Information
Client Concerns
Financial Policies and Fees
Disclosure Statement (Gresham Office)
Disclosure Statement (Sandy Office)
Notice of Privacy Practices
Other Forms:
Release of Information
Transfer Plan
Copyright 2009 by Dina Yerex, LPC, CADC III, CGAC II. Last updated 01/17/12.
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