Behavioral Health Group Interest Form

Behavioral Health Group Interest Form
Are you a patient of One Community Health?*

YesNo
Which groups are you interested in?*

It Takes a Village (Hood River): support group for parents of children with complex health needsMany Paths to Recovery (Hood River): non-judgmental and accepting group environment to build community and hope through positive relationships and peer supportMany Paths to Recovery (The Dalles): non-judgmental and accepting group environment to build community and hope through positive relationships and peer support
Patient Name*

First NameLast Name
Patient Date of Birth*

MonthDayYear
Date
Parent/Guardian Name

First NameLast Name
Parent/Guardian Date of Birth

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
At this time behavioral health groups are only open to patients of One Community Health. If you would like to become a patient call us at 541.386.6380 or visit https://www.onecommunityhealth.org/scheduleappointment.
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