Quest Center for Integrative Health Referral Form

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Thank you for your interest in Quest Center! We offer a variety of services for: Chronic Pain Management, Mental Health Services, HIV Services, Substance Use Services, and more!

Please take approx. 5 minutes to complete the following form. We will follow up within 3-5 business days with more information and next steps. To access this form in Spanish please click the link: Here.

Please note that all Mental Health Program Waitlist Requests must be self-referral by the individual seeking services, 18 years or older (not for use by case managers, peers, friends, or family).

You can submit a self-referral waitlist request for Quest Center for Integrative Health's Mental Health Program in English by clicking this link: Here. This will take you to a separate form for completion. To access this form in Spanish, access the form here: Solicitud de lista de espera para servicios de salud mental de Quest Center

If you have any questions, please call our front desk at 503-238-5203 for assistance.

Email *

Are you submitting this referral as: *

Self-Referral [I am filling this out for myself]

Outside Agency Referral [I am filling this out for a client]

Quest Staff Member

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