Forms to Download

Valley Mental Health Home

Frequently Asked Questions

Natural Supports

Career Opportunities

Forms

Kathleen Baptiste LCSW

Sandra Bassett PMHNP

Vivien Bliss LPC NCC MAC

Kathleen Boyle MSW

Melissa Bravo MS

Tom Breyer RN MS ANP PMHNP

Kim Buller LCSW

Jennifer Carley RN MS PMHNP

Lori Doede LPC MAC

Amber Donaldson MA

Margo Eliescu LCSW

Corrine Elms LPC

Amber Eriksson PMHNP

Christine Ertl LCSW

Penny Huyck LPC

Winifred Ju PhD

Glenn Koppang MA MFT

Rosanna Krenz MA

Dawn Leon MA

Cheryl Meyers LCSW

Pamela Lyons-Nelson MS LPC

Mat Nyquist MS

Gil Nicholson-Nelson LCSW

Kathy Outland MSW LCSW

Patricia Parezo MA LPC NCC

Dublin Popov LCSW

Denise Smith LCSW

Rhonda Stovin MSW LCSW

Rick Swope MEd LPC CCBT CRC NCC

Reid Thurston LCSW MAC

Gail Wiebe PMHNP

Carey Zeeb MA LPC

Salem Psychiatric Associates Home

Policies and Procedures

• View our privacy practices and other policies by clicking on the following links
  • Our Privacy Practices
  • Patient Rights and Responsibilities
  • Grievance Procedure
  Or you can download our privacy practices and other policies in pdf format.  
  • Our Privacy Practices
  • Patient Rights and Responsibilities
  • Grievance Procedure
  • Complaint Form

  Intake Forms

• Download our adult intake form and fill it out at your leisure in the privacy of your own home before coming in for your initial appointment.
• Download our children intake (0-5 yo) form and fill it out at your leisure in the privacy of your own home before coming in for your initial appointment.
• Download our children intake (6-17 yo) form and fill it out at your leisure in the privacy of your own home before coming in for your initial appointment.
• Download our patient information form and fill it out at your leisure in the privacy of your own home before coming in for your initial appointment.
• Download our HIPPA form - Confidentiality form
• Download our ROI - Release of Information

  Formularios en Español

• Questionario para Adultos - Rellene y entréguelo cuando tenga la primera cita con nosotros
• Questionario para niños de 0-5 años - Rellene y entréguelo cuando tenga la primera cita con nosotros
• Questionario para niños de 6-17 años - Rellene y entréguelo cuando tenga la primera cita con nosotros
• Formulario de Información del Paciente - Rellene y entréguelo cuando tenga la primera cita con nosotros
• Formulario HIPPA - Formulario de confidencialidad
• ROI - Divulgación de Información del paciente.
  

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