Client Forms

If you are new, please be sure to fill out the following forms, and bring them to your first session. This will help ease you in and allow as much time as possible to focus on you.

Client Intake Form

Information Sheet

Limits of Confidentiality

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information

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132 E. Broadway, Suite 323
Eugene, OR 97401

(458) 201-0125

cjh@caroleejhorningcounseling.com

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By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

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About My Practice

My practice specializes in treating individuals and groups and through years of experience, I’m confident that no problem is too great to overcome.

Office Hours

Monday – Thursday 9 am to 6 pm
Closed Friday, Saturday, Sunday

Contact Information

132 E. Broadway, Suite 323
Eugene, OR 97401

(458) 201-0125
cjh@caroleejhorningcounseling.com

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