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: [email protected]


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

Release of Information Documentation
English      Spanish

Sliding Fee Discount Program Application
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 intellectual/ developmental disabilities (DD), 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 are an adult seeking mental health or substance use you can also simply walk in without an appointment to be assessed (listed below) during our Open Access times. This enables you to access services without an appointment, on a first come first service basis. After the initial assessment is completed you will be able to engage and schedule all future appointments with the clinician you saw for the assessment. Our hope is to better support our community in connecting with treatment when it’s needed most.
  • 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- Ethel Marquez 541-716-4120

The Dalles- Bobbie Napoli 541-716-4232

Open Access

Current Open Access Times are as follows:

 Mental Health Substance Use Treatment
Monday8:30 AM9:30 AM1:30 PM2:30 PM
Tuesday1:30 PM2:30 PM8:30 AM9:30 AM
Wednesday8:30 AM9:30 AM1:30 PM2:30 PM
Thursday1:30 PM2:30 PM8:30 AM9:30 AM