Contact & Helpful Forms

Fawn Gonzales, LCSW

Independent Practitioner

The Sharing Place

A Counseling Center

14 Cottage St.

Medford, OR 97504

For inquiries or to make an appointment:

(541) 944-7711

(541) 779-2390

(541) 779-3260 (fax)

[email protected]

Parking lot provided for your convenience.

Helpful Forms

To maximize our time together please print and fill out the following forms prior to your first appointment. If you would like me to coordinate care with a primary care physician, school, and/or other providers, please print out a Release of Information for each provider.

If you do not have access to a printer, please arrive 20 minutes prior to your scheduled appointment and the forms will be available for you to fill out at my office.

Client Information Paperwork

Initial Evaluation Questionnaire

Release of Information Form

Credit Card Authorization Form

Telehealth Consent