Inquiry for Therapy Services

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Bird Weaver Solutions is a safe, trauma engaged, welcoming service provider.

In fact, we will celebrate you. The real you(s).

Please complete this form to apply to my waitlist. I have openings monthly, so it benefits you to add your name sooner than later. Neither of us is committed to services by your submission of this form, you will always have a choice about engaging in services. This is just to begin a conversation between us.

You will receive a confirmation email with further information and next steps when you submit this form.

I review applications weekly and will notify you as soon as possible if we are not a good fit. I will also provide several referral options to support your search for a therapist.

Please be aware that you must physically be in the State of Oregon to receive therapeutic services.

Email *

First Name *

Last Name *

Type of therapy you'd like, select all that apply

Individual Therapy for an Adult

Partnership Therapy (couples+ welcome)

Family Therapy, Adults Only

Family Therapy, Children included (individual sessions with the child will occur with this option)

Group Therapy, Trauma Focused please be aware that this is online only

Required

Why are you seeking services at this time?

What are your top two concerns? Top three if you are a partnership or family.

How did you hear about me? *

What appeals to you about the services I provide? *

Are you interested in participating in research? Your Identifying information remains absolutely confidential. *

Yes

I understand that Bird Weaver Solutions, LLC does not participate on insurance panels and does not bill insurance for services. I understand payment is due at or prior to time of services.

Yes

I acknowledge that I have viewed the complete video(s) on this page and read the accompanying information. I understand that my information will be added to a waitlist and this form is not an agreement to provide or participate in services. I agree to be contacted by email to arrange for a consultation if services are appropriate.

Yes

I also consent for this website to collect this information consistent with this website's privacy policy.

Yes

Send me a copy of my responses.

Submit

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