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INTAKE FORMS

 Please Complete All Forms Before Your First Meeting 

intake Information form

HIPPA Notice of Privacy

HIPPA FORM

Office Policies and Payment for Services

Office Policies

Costs for Services

Therapy

$175 per Hour

Individual, couples or family Therapy

Parenting Plan Mediation

$200 per Hour

Parent Consultation

$175 per Hour

Adam Furchner, Ph.D.

1525 NE Weidler, Portland, OR 97232

AdamFurchner@comcast.net

Copyright © 2025 Adam Furchner, Ph.D. - All Rights Reserved.

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