Waitlist for Christo Brehm (Inner Room Somatic Therapy)

Current Availability: When my practice is full, I operate from an actively monitored Waitlist. Space for new Clients usually opens up when an existing Client graduates or leaves my practice, the timing of which can be hard to estimate. If you are interested in working with me, I encourage you to register.

Specific Days and Times: When I do have availability, it is going to be for a specific day and time since I block out a regular day and time each week for nearly all of my clients. Even if we both mutually feel like a great fit for working together, finding a mutual day and time in our schedules is critical. I encourage you to be as flexible as possible when you indicate your availability.

Next Steps After You Submit This Form: Once space opens in my practice, I will contact you to confirm that you are still interested and schedule a no-fee initial consultation where we can get to know each other better.

Crisis and Emergency Situations: If you or someone you know is experiencing a mental health emergency or crisis, please do not wait until space opens in my practice to get help.  Anywhere in the United States, you can call the National Suicide and Crisis Lifeline by dialing 9-8-8.  In the Eugene, Oregon area, you can also call Whitebird Clinic's 24/7 crisis line at 1-800-422-7557 or physically walk into the Hourglass Community Crisis Center, also 24/7, located at 71 Centennial Loop, Suite A, Eugene, OR, 97401.   In addition, you can go to your nearest Urgent Care, Emergency Room, or if experiencing something life threatening, dial 9-1-1.

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Email *
Today's Date *
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Do you live in Oregon? (Due to licensure laws, I only provide services to people within the state of Oregon) *
Why do you think I might be the right counselor for you? Please reference my specific training, bio, and the approaches to therapy that I emphasize.
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First Name *
Last Name *
Your Date of Birth
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Phone *
Address
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How did you hear about me, or who can I thank for referring you?
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What brings you to counseling at this time? *
When did these issues start? Was there a specific event that you experienced? *
If counseling is successful, what will be different in your life once we are done?
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How do you prefer to meet?
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Required
Please indicate days and times you are available for 1 hour (53-55 min) weekly sessions. The more inclusive you can be, the more likely we can find a mutual day and time that works for both of us.
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Monday
Tuesday
Wednesday
Thursday
Friday
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
Are you willing to book and manage your own appointments using my online scheduling service? (I am happy to initially book out a bunch of weekly appointments for our standard day/time but I ask clients to manage changes to the standard schedule.) *
Do you have any conditions (e.g. recent concussion or TBI) that make using a computer screen challenging or uncomfortable?
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Form(s) of payment (mark all that apply)
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Required
Is there anything else you'd like me to know about you?
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