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Sometimes it can be helpful to have paperwork filled out before you arrive. You will find  forms that you may need listed below.


For Vocational Rehabilitation Counselors: 

 For Vocational Rehabilitation Clients:

For Counseling Clients:

If you would like Dirkse CC to coordinate care with another provider (for example: your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information: 

  • Authorization to Disclose Information

Note: To download Adobe Acrobat Reader for free, 
click here.



For Referrals or Inquiries: 


Phone: (503) 265-9256
Fax: (503) 672-7668

8555 S W Apple Way
Suite 320
Portland, OR 97225
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