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