PROVIDER REGISTRATION

Please register in this database only if your organization is able to provide direct services that are culturally and linguistically specific to Latinos. If you are with an organization that has numerous programs, please fill out a separate questionnaire for each program.

REGISTRATION FORM

ORGANIZATION INFORMATION
Program Name: (*)
Organization Name: (*)
Contact Person Name : (*)
Write here the name of the person in charge of making changes in this registration. REDES will send emails for updates.
Program Main Address: (*)
ZIP code: (*)
Contact Person Phone: (*)
Contact Person Fax:
Contact Person E-mail: (*)
Organization Website:

SERVICES INFORMATION
Services provided: (*)
Mark "Other Mental Health related services" if you provide other mental health related services not included in this list, and describe them in the "description of services" section below.
 
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Description of Service(s): (*)
Specify in detail: description of your program, areas of specialization, requirement for admission
 
Please list here all the bilingual/Spanish speaking providers in your program currently offering direct services to Latinos. Those listed here will receive regular emails about REDES events:
Provider Name:
Provider Credentials:
E-mail:
Telephone:
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Location of Program offices: (*)
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Population served: (*)
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Referral Process: (*)
Please be specific: phone number to call, intake process, who would the client have to talk to first ?. Are there any steps the client has to take before seeing you ?. Do you prefer the client to call you directly or do you prefer the referral agency to call you with client information ?. Is the referral process different for monolingual Spanish-speaking individuals and/or for bilingual clients ?.

PAYMENT INFORMATION
Payment type: (*)
Please mark "Other" if there are specific requirements clients must meet to receive free services, and describe these in "description of services offered" section above.
 
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The inclusion of a mental health provider in this directory does not represent an endorsement of the provider or of the services the organization may provide. This directory is not intended to be a complete listing of bilingual or bicultural mental health providers in Oregon. The sole purpose for the creation of this Directory is to facilitate access to culturally appropriate resources.



 
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