New Patient Forms
Step 1:
Please complete the counseling inquiry form and provide our office with your information. Once completed someone from our administration staff will reach out to you for the next step.
Counseling Inquiry & Insurance Information
Step 2:
Once you have heard back from our team, please complete ALL the necessary paperwork (will be listed in the email from our office). Once all the paperwork has been received, someone from our office will reach out to get an appointment scheduled.
New Patient Intake Packet
Couples Counseling Questionnaire
Individual Counseling Questionnaire
Child Counseling Questionnaire
Two-Way Records Release
Referral Form
Effingham School Telehealth Programs
Step 3:
Sign up for our client portal. Enter your information below to create a client portal account. If you are a parent or guardian creating an account for a minor, please enter their information.