Appointment Request Form

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Client’s preferred Counselor?

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Steps to complete New Client Registration:

  1. Wait for an access link to be sent to your email, 24 hours or less.
  2. Login and complete the New Client Registration Form.
  3. Provide demographics, insurance information and consent.
  4. Submit the registration form and any payments due before your first appointment.
  5. Schedule your first appointment with your designated counselor.
  6. For assistance, call 904 213-8188.