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Forms

Checklist

New patient forms

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Payment Policy

Attendance Policy 

Permission to bill credit card

Photograph and video release

Attendance Policy OHP

Release of Protected Health Information

Permission to Bill Credit Card on File

HIPPA Privacy Notice

Authorization  to release healthcare information

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New child patient forms

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Case History questionnaire 

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Whispering to Granddad

New adult patient forms

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Adult fluency voice questionnaire

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Adult rehab intake form

Drop us a line today to learn more about our online or in person therapy!

Sunbreak Therapy Services

info@sunbreakclinic.com

Phone: 503-266-1030

Fax: 971-244-9044

Canby clinic address:

366 N Holly St

Canby, OR 97013

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Portland clinic address:

6516 NE Siskiyou St.

Portland, OR 97213