Preparing for your Visit

Preparing for Your Visit

New Patient Forms

The Referral Coordinators assist in the processing of potential new patients for all services to Mid-Columbia Center for Living. The intake packet must be presented to Mid-Columbia’s Center for Living Referral Coordinators.
Please download any of the following forms that are applicable to your referral and contact our Intake Referral Coordinators .

Registration Documentation

Please fill and print intake packet and bring with you on your appointment or download. Send by email to:


Required Documentation

The intake packet includes state required demographic  information, an optional  voter registration form, an Income and Benefit statement, Referral and Contact Information and a consent to treatment, confidentiality and information  on services.

Intake packet
English       Spanish

Client e-Mail and Text Message Consent
English       Spanish

Consent to Participate in Telehealth Services
English       Spanish

Informational Documentation
English       Spanish

What to  Bring Checklist

  • Insurance Card
  • New Patient Forms
  • A list of all medicines; prescription and over the counter (name, dose, and frequency taken) that you are currently taking.
  • A list of any medications that you have allergies to or have experienced an adverse reaction to in the past.
  • Any documents that might be pertinent to your treatment (previous psychological testing, hospital discharge summaries, recent laboratory results, etc.).

General Appointment Information

How do I access services at MCCFL?

If you are seeking services for mental health (MH) and/or substance use disorders (SUD) you can always reach out to our Referral Coordinators for information and support in getting enrolled.

  • If you speak Spanish, all services will need to be scheduled through our Referral Coordinators for both MH and SUD services.
  • If you are a youth or seeking services for one, all services will need to be scheduled through our Referral Coordinator for both MH and SUD services.
  • If you are making a referral for services, we will continue to keep the referent up to date on all the referrals received in our offices, in a timely manner. To help us be able to communicate with you, please have clients complete a Release of Information and send to us at your earliest convenience.

Referral Coordinators

If you have any questions please call our referral coordinators for assistance.

Hood River- Rachel Millard 541-386-2620 ext 2107

The Dalles- Yeimi Andrade 541-296-5452 *Se habla Espanol