New Client Contact Form

Waitlist Full. Please check back in November.

Please complete the contact form below and Sarah will reach out if she has an opening for you.

Name

First Name

Last Name

Phone

(###)

###

####

Were You Referred By Anyone?

(Optional) Please list the name of the individual or organization who referred you.

Payment Type

Cash Rate

Insurance

Insurance Information

If you plan to use insurance please list your provider.

Why Are You Seeking Support?

Please include some basic information on why you are seeking support. This section helps Sarah determine if she is a good fit for your situation.

Appointment Frequency

Sarah sees most new clients on a weekly basis. Will recurring sessions work or are you looking for something different?

Yes, weekly session work for me.

I'm looking for sessions every 2 weeks.

I'm not able to commit to weekly or semi-weekly sessions at this time.

Sarah Kaufman Counseling
3575 Donald St, #610
Eugene, OR 97405

Welcome    About    Client Portal

© 2025 ALL RIGHTS RESERVED