To find out more about embarking on the life you have always wanted but could not imagine having, please contact Capstone Counseling, LLC at: 503-980-5322 or My fax number is: 503-981-0817.

After we have agreed to begin a therapeutic relationship, you may fill out the Professional Disclosure Statement below. When you have submitted that first form, the Confidential Intake Form will automatically load. Please complete and submit that second form also. Please fill out and submit both secure forms prior to our first meeting, and ONLY for the person(s) to receive counseling services. (For example, if you are a parent with a child needing therapeutic services, please complete the two forms with the child's information, not your own.)

WARNING: Do not press the "RETURN" key while completing these forms. Doing so will promptly submit the form to Capstone Counseling, LLC, even if you are not finished. In that event, you will have to start over. When filling out the confidential intake form, please also bear in mind that if you have more than one child and/or sibling to list, you can click on "+add new row" to list additional children and/or siblings.

Again, please be sure to fill out BOTH of the forms, beginning with the Professional Disclosure Statement linked below:

Thank you very much. I look forward to meeting you!

   Copyright © Johnnie C. Burt, Capstone Counseling LLC, 2005-2019
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