(503) 701-1050 | guy@guyburstein.com

Guy Burstein

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Client Forms

If you are new to therapy or counseling, please be sure to fill out the following forms, and bring them to your first session. This will help ease you into therapy and allow as much time as possible to focus on you.

New Client Intake Form

Guy Burstein, LCSW



(503) 701-1050
guy@guyburstein.com

833 SW 11th Ave Suite 214
Portland, OR 97205

Send A Message

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

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Contact Information

833 SW 11th Ave Suite 214
Portland, OR 97205

(503) 701-1050
guy@guyburstein.com

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