Provider Connection Form

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Expanding upon our community partnerships and referral network is important to us. We appreciate and acknowledge there may be additional community-based resources that would be beneficial to our clients along their recovery journey.

Please fill out this form on behalf of the organization you represent to express interest in collaboration with the Deflection - Pathway Center - Multnomah County team.

Provider Connection Form submissions will be reviewed on a regular basis – please expect all submissions providing services relevant to our population’s needs to be contacted within 15 business days.

Email *

What is your name and professional role at the organization you are representing? (Please provide your first and last name.) *

What is your phone number?

What is the organization's name? *

What is the organization's website? *

Please indicate the types of services the organization offers that you believe may complement the Coordinated Care Pathway Center's programming: *

Withdrawal Management

Outpatient Treatment

Inpatient Treamtnet

Shelter or Housing

Peer Support

Other:

Required

Is there any other information you would like us to know?

Send me a copy of my responses.

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