Thank you for your interest in PTCTM groups! Please take a moment to complete the form below, or you can contact the Program staff directly. Andrew Stevens(541) 743-4351OREvyan Stuart(541) 743-4348 Please enable JavaScript in your browser to complete this form.Name *FirstLastChild's NameFirstLastChild's Age *Please share why you are seeking services or list the behaviors of concern. *County of Residence: *InsuranceMy child has Oregon Health Plan, orMy child is uninsured or has commercial insurance and I would like more information about eligibility for PTC group.Phone *Contact Email *What is your preferred method of contact? *EmailPhoneTextBest time of day for us to contact you?How many children under the age of 18 are residing in your home?Preferred group time? (Check all that apply)MorningAfternoonEveningHow did you hear about Parenting through Change? *WebsiteSubmit
