912-349-8043 New Patient Forms

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

Online Form

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

Online Form
Print PDF

Couples Counseling Questionnaire

Online Form
Print PDF

Individual Counseling Questionnaire

Online Form
Print PDF

Child Counseling Questionnaire

Online Form
Print PDF

Two-Way Records Release

Online Form
Print PDF

Referral Form

Online Form
Print PDF

Effingham School Telehealth Programs

Two Way Release Form
Online Referral Form
Print PDF

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