Skip to content
Home
Our Team
Services
Outpatient Counseling
Wise
Peer Hubs
Foundational Community Supports
Peer Respite
3RT CORE
Medication Management
Group/Workshops
Insurance
Forms
Employment
Contact
Home
Our Team
Services
Outpatient Counseling
Wise
Peer Hubs
Foundational Community Supports
Peer Respite
3RT CORE
Medication Management
Group/Workshops
Insurance
Forms
Employment
Contact
Patient Forms
Before your intake with Three Rivers Therapy, you will receive your intake paperwork via email through PandaDoc. If you encounter any issues submitting the forms or have not received them, please contact our office at 509-378-5553. Thank you.
2024/2025 hipaa notice of privacy practices
client rights statement
Welcome! Start as a new client or refer someone.
{"field_e0e0687":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Patient","_id":"7e0e8fb"}]},"field_7b23bf0":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Patient","_id":"7e0e8fb"}]},"field_2d9bade":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Patient","_id":"7e0e8fb"}]},"field_b340773":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Patient","_id":"7e0e8fb"}]},"field_658cf5a":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Patient","_id":"7e0e8fb"}]},"field_d8477f7":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Patient","_id":"7e0e8fb"}]},"field_4fbdb97":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Patient","_id":"7e0e8fb"}]},"field_7996ad9":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Referring Provider","_id":"7e0e8fb"}]},"field_0cc4303":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Referring Provider","_id":"7e0e8fb"}]},"field_55d0e02":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Referring Provider","_id":"7e0e8fb"}]},"field_7f344ac":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Referring Provider","_id":"7e0e8fb"}]},"field_34c9c23":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Referring Provider","_id":"7e0e8fb"}]},"field_48dc700":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Referring Provider","_id":"7e0e8fb"}]},"field_ae38e57":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"name","cfef_logic_field_is":"==","cfef_logic_compare_value":"Referring Provider","_id":"7e0e8fb"}]}}
Which one are you?
Patient
Referring Provider
Patient Name
Patient Phone
Patient E-mail Address
Patient D.O.B.
Best day for appointment?
Monday
Tuesday
Wednesday
Thursday
Friday
Time of day?
Morning
Afternoon
Evening
Program Interest
Outpatient Counseling
Medication Management
WISe
3RT CORE
FCS
Peer Hub
Kids/Parent Group
Provider Name
Patient Name
Patient D.O.B.
Patient Phone Number
Patient Insurance Provider
Notes/Requests
Program Interest
Outpatient Counseling
Medication Management
WISe
3RT CORE
FCS
Peer Hub
Kids/Parent Group
Send
