Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Please complete all fields. If you would like us to bill your insurance, please add your insurance information. We will call you to discuss your insurance benefits and / or payment options and to schedule an intake appointment.
** We are a gender identity expansive and affirming practice. Please note that the gender options are limited due to requirements of insurance company billing. Please choose the option that corresponds with your legal gender.


Client Type

Client Information

/ Middle Initial

( optional )


( for Text Message Reminders )

Bill To Contact

/ Middle Initial

Emergency Contact

First Name
Last Name

Log in Details

( If client is a minor, the legal guardian must enter their email address below. )

Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )

( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

Physical Distancing and Infection Control Statement of Understanding
Pursuant to Governor Brown's Executive Order No. 20-12 regarding COVID-19, and until further notice, Oregon EMDR, LLC will continue to provide tele-medicine[1]  to the maximum extent possible considering the health and safety of all individuals, as well as, access or barriers to effective participation in telemedicine services.  The availability of in-person services will be determined by providers based on the above criteria.  NO EMPLOYEE OR CLIENT WILL BE REQUIRED BY OREGON EMDR TO PARTICIPATE IN IN-PERSON SERVICES FOR THE FORESEEABLE FUTURE.

A review of the CDC, National Association of Social Workers (NASW) and American Psychological Association (APA) guidelines for in-person behavioral health therapy services in the absence of proven treatment or vaccine for Coronavirus informs Oregon EMDR's policy to offer limited in-person sessions beginning the week of June 7, 2020 as Governor Brown has approved Lane County for Phase 2 re-opening.

Informed consent includes the following disclosure: 

The Centers for Disease Control (CDC) reports that individuals meeting criteria below ARE AT A HIGHER RISK for developing Coronavirus and experiencing more life-threatening symptoms if infected:

Based on what we know now, those at high-risk for severe illness from COVID-19 are:

●     People 65 years and older

●     People who live in a nursing home or long-term care facility

●     People of all ages with underlying medical conditions, particularly if not well controlled, including:

●     People with chronic lung disease or moderate to severe asthma

●     People who have serious heart conditions

●     People who are immunocompromised

       ○   Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ            transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications

●     People with severe obesity (body mass index (BMI) of 40 or higher)

●     People with diabetes

●     People with chronic kidney disease undergoing dialysis

●     People with liver disease

●     People with Asthma

Additionally, the following population groups are at greater risk for Coronavirus:

●     People experiencing homelessness

●     People in racial and ethnic minority groups

●     Pregnant people

●     People of with physical disabilities or challenges

The following physical distancing and infection control measures will be required for those participating in in-person services. 

●     All providers and clients will wear masks AT ALL TIMES while in our office and in the presence of other persons.  Masks will be provided to anyone who needs one if they are available. 

●     All providers and clients will use hand sanitizer upon entering the building and after every contact with bodily fluids, e.g., after coughing or blowing one's nose.

●     Oregon EMDR will provide disposable gloves to those who request them if they are available.

●     All providers and clients who experience Coronavirus symptoms or are knowingly exposed to Coronavirus will refrain from coming to the office for 14 days after the onset of symptoms or date of exposure.

●     The waiting room will remain closed.  Clients will be asked to wait outside or in their vehicle until their provider calls them to invite them into the office. 

●     Clients for whom providers have determined adequate access to tele-medicine services will be offered referrals to outside providers should they decline tele-medicine services.

( Type Full Name )