Thank you for your interest in our services. We can best answer you questions by knowing a little bit about your child. Take a moment to fill out the short online form and someone from Bridges will contact you shortly.

Name *

Name

First Name

Last Name

Email Address *

Phone number *

Address *

Child's name *

Child's DOB *

What services are you interested in? *

One-on-One therapy

Social Skills Group

Parent Training

School Support

Community Support

Description of your child's strengths and challenges *

Are you accessing other services? If so, what is your current schedule? (ie. school, OT, PT, Speech) *

Please be as descriptive as possible. Give an exact breakdown of current services, school and other activities.

Medical Insurance *

Diagnosis *

Please include when, where and who conducted the diagnosis.

503-235-3122

971-279-4655

4724 SW Macadam Ave. Portland, OR. 97239

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