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Forms

Ocean

EMERGENCIES

NEW PATIENTS

FORMS

MEDICATION

INSURANCE

GOOD FAITH NOTICE

CONFIDENTIALITY

KEEPING HEALTHY

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New Patient Request Form

Mind Matters, P.C. provides quality multidisciplinary evaluations and treatment for psychiatric disorders. We treat children, adolescents, adults and families.  Our clinical team will determine which clinician is best suited to meet your needs after receiving the completed “New Patient Request Form”. If you have questions, call our office for details at (503) 352-0468 or (971) 703-1020.

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  • We will reach out to initially schedule a series of appointments and recommend a treatment plan. 

  • Initial appointments are available with our Psychiatrists or Psychiatric Mental Health Nurse Practitioners (Our therapists and Psychologists typically are available by internal referral only. 

  • Please note, We do not currently bill or participate in Medicare or Medicaid plans.   
     

For Referring Providers:

We welcome your referrals to our Psychiatrists and Psychiatric Mental Health Nurse Practitioners. Please fax your referral request to (503) 352-1024.  Please call our office if you need assistance.

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To become a Mind Matters PC Patient:​

  1. Please fill out the fillable intake form completely (see below) and save
    it to your device. 

  2. Submit your request by uploading the completed intake form and
    insurance card to us 

  3. We will reach out to contact you. If you have questions or need
    assistance,  feel free to contact our office.

Intake Form

For Psychiatrist and Psychiatric Mental Health Nurse Practitioner requests only. If requesting therapy only, please call our office 

If a question does not apply but the field is required, indicate N/A for “not applicable”. Please fill out form completely . Asterisk designates required information. 

Date Completed
Month
Day
Year
Sex (required by EMR System)

If Applicable

Financially Responsible Person (Guarantor) - Must be same person who signs patient Financial Responsibility Form. This is who will receive and is responsible for the bill. Mark one: 

Treatment-Related

Reason patient is needing to be seen (Check all that apply) * 

Insurance Information (Please note: we do not currently accept Medicare, Med Advantage, or Medicaid plans.) Please submit copy of insurance card(s). If private pay, please indicate .

PDF or JPG Format

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 Phone (503) 352-0468/fax (971) 703-1019​​​

BEAVERTON /TIGARD

8905 SW Nimbus Ave, Suite 300, Beaverton, OR 97008

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© 2023 Mind Matters ,PC. All rights reserved. 

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