Linda S. Stead, LCSW Heartline Mental Health Practitioners, LLP 255 W. Stewart Ave. Ste. 101 Medford, Oregon  97501 (541)772-5992 FAX: (541)772-5996 lstead@lend-an-ear.com First Name: Last Name: Address Street 1: Address Street 2: City: Zip Code: (5 digits) State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Daytime Phone: Evening Phone: Email: Prospective new clients please include a brief description of your symptoms and/or the issues you would like to address.  If you have already spoken to me by phone and are in the process of setting up appointments, please list your insurance details here, including a phone number to check benefits.  This is usually found on the back of the card. Comments: Enter comments here!