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Making A Referral

1. Please download the referral information form. Referral Form
(Adobe Acrobat is required to view the form. Click here to download.)

2. Complete the referral form to the best of your ability.   Forms that are missing information will take us longer to research, which in turn will delay the time it takes us to get back to you and eventually place the client.

3. Please provide payment information including insurance benefit information. Your insurance company’s customer relations number should be listed on the back of your insurance card.  If you are a provider making a referral, please obtain this information from your client.

4. Fax the completed referral form and if you are planning to use insurance, a copy of your insurance card (front and back) to: Attn: Intake Coordinator at 458-226-2072.

5. Our Intake Coordinator will attempt to call the client (or family member if appropriate) within two business days after receiving the form.  If you are a provider making a referral,  please alert your client ahead of time that we will be calling them. 

6. Once the client is matched with a therapist, he/she will attempt to call the client (or family member if appropriate) to set up a first appointment. First appointment information is available on our website. 

Additional Questions

If you have a referral question not answered on this webpage, contact our Intake Coordinator via email at

getting.started@dbtcenterso.com  Or call her at 541-621-0303.
If our Intake Coordinator is on the line with another call or if it is after-hours, please leave a message and she will attempt to return your call within 3-4 business days.   


Please Note:
-When you leave a message, please indicate the best days and times to reach you.  
-Unless you tell us otherwise, we will leave a message if you are unavailable.
-We will attempt to reach you three times.  After that it will be up to you to re-contact us. 
-We are not a crisis line or emergency service provider. If this is a crisis situation, please call
Description: http://www.portlanddbt.com/Images/SPACER.gifyour local crisis line or go to the nearest hospital emergency room.